Preface   

This book will cover a subject that is near and dear to my heart, that of aging. I am currently 59 years old. While in modern society this is not an extremely old age, I am still experiencing a decrease in my ability to perform certain tasks. As is the case in many of my recent books and my Blog articles I have taken important subjects and attempted to presents them in a thorough and easy to understand manner. As has been the case with many of my books, I have published them in multiple formats and I have even provided copies in free forms, both on my blog “common-sense-in-america.com” in the written form and in the audio form on my podcast “Common Sense And Ramblings In America.”This book will be no different, however, I won’t publish this book as I go and in multiple parts on my blog, it will be published after I have completed it in its entirety. I am doing this to streamline the whole process. When I publish in on my Blog first, I have to reformat it for my book. This takes more effort and time, of which I have little to spare.

I hope you find this book entertaining and enlightening.

 Table of Contents

Preface
Introduction
Chapter1–Pregnancy
Chapter 2–Infancy
Chapter 3–Toddler
Chapter 4–Childhood
Chapter 5–Puberty
Chapter 6–Adolescent/Teenager
Chapter 7–Early Adulthood
Chapter 8–Middle-age Adults
Chapter 9–Late Adulthood/Senior Years
Chapter 10–Living a Healthy Lifestyle
Chapter 11–An Apple a Day Will Keep the Doctor Away
Chapter 12–The Importance of Companionship in the Elderly
Chapter 13–Maintaining a Bright Outlook on Life
Appendices
Appendix A–Treating Infertility
Appendix B–Prenatal Care
Appendix C–Can Diet Prolong Life?

Introduction

I came up with the idea to write this book on my last road trip to Utah with my wife Connie. The trip was a comedy of errors. Every step of the way we were thwarted by some roadblock. We made so many changes to our plans, that we both ended up not bringing important items on our trip. Mind you none of them prevented us from taking the trip, they just made our lives more difficult by not having them. I have covered this topic quite extensively in the 2nd edition on my travel book. Suffice it to say that one omission really drove home the point of aging. We had planned on doing some overnight backpacking, which necessitated bringing with us a small two person tent. We had also planned on doing some car camping or “glamping” as well. For that we were going to use a large 6-person tent, that we could stand up in. Well guess what I forgot to pack? You guessed it the bigger tent. So now we had to use the small tent. What added insult to injury due to weather conditions we were not able to do the backpacking at all. After 5 nights of sleeping in that tent, my back and body in general was doing some serious rebelling. Since none of our camp sites had showers, we spent 4 nights in hotel rooms to clean up and to also get a good nights sleep. If you were to chop off 20 years from my life, we would have not needed those recovery nights in the hotel.

Even though I have covered this subject thoroughly in the second edition of my travel book I do want to discuss this trip with a different perspective in mind. If you have read any of my books you will know that I have many interests and hobbies. One is photography. Photography has been a part of my life for well over 40 years. I had wanted an SLR camera since I was a teenager. My parents were not well to do, so I did not get first camera until I got a job and I bought one when I turned 20 years of age. I have even wrote a four volume encyclopedia on the subject.

Just recently I became interested in astrophotography. Since the night skies are very dark where we were going, I planned on bringing my gear with me. With the tripod, camera, lenses and tracker, we were talking about an extra 25 pounds of gear. The hike was going to be around 12 miles round trip. The problem is that the spirit is stronger than the flesh. I am fast closing in on 60 years of age. Just 10 years ago I hiked 10 miles to Havasupi Falls with a pack weighing in excess of 80 pounds. It was so damn heavy that I had to put it on the tailgate of my pickup truck to put it on. There is no way I could do that now. Age has a way of creeping up on you.

Fortunately or unfortunately the weather did not permit me to test out my folly. I did several other day hikes on the trip, and each time I thanked my lucky stars that I was not carrying that extra weight. So it was in the middle of one of my hikes when I decided to write this book. I will discuss both physical and mental development and maturation in this book. You pretty much can’t have one without the other after all.

My stepfather used to say that your body has a memory of its own. Everything you do to it will Coe back to haunt you. He was so right. While I never played organized sports I did however work very hard all my life and I also participated in endurance sports. Both of these activities definitely take their toll on your body. I know the pain I experience each and every day, so I can’t imagine the pain professional football players must experience when they get older.

Another thing that tent camping gives you is a lot of time to think, because once it gets dark, there is not a whole lot of things to do but sleep or in my the former. My back just did not allow for 8 or more hours of sleep. Since we had not anticipated the inclement weather and also the lack of a large tent, a portable heater was not brought or even feasible if we had brought one. So we were bundled up to stay warm, however the cold still managed to cause some discomfort for my old bones. Like I said already getting old sucks, especially when your brain hasn’t yet come to grips with this fact. I still want top do all the things that I did when I was younger. So during all this down time, I started mulling over the whole aging process and what I might have done differently to make my aging process to be a little smoother.

After a great deal of deliberation I decided to shelve at least temporarily my plans for my historical novel trilogy and to write a book about the aging process. I also decided to update my travel book, which At the time of writing this book, I have already done. I have decided to break this book up into the stages of growth and aging from inception to death. I have covered quite extensively healthy living and dieting in my weight loss book, so I will only touch lightly on that subject here. However, I will devote quite a bit of time and space on how to delay the aging process and its effects, by exercise both physical and mental. I will also discuss the need for companionship (pets do count) and the benefits of maintaining an active lifestyle. You need to have something to look forward to keep your morale up and your outlook on life positive. Another topic I will cover is staying on top of your medical health, by following up with your doctor and getting regular Wellness checks and taking the appropriate medications, especially those for blood pressure control and diabetes if indicated. These of all the health issues cause the most problems in maintaining a healthy lifestyle.

Finally I will include an Appendix which will include important information on various health related matters that I believe are not only important but germane to the subject matter in this book.

Of special note, the developmental stages of life are complicated, especially during the early years. I have tried my best to be consistent with my staging, especially in regards to the ages they take place. However, many experts have different ideas on the ages that these changes actually take place. The development of the child may also vary from individual to individual. So don’t get too caught up with the ages that are listed, especially in Chapter 5 and Chapter 6.

Chapter 1-Pregnancy
The development of a zygote into an embryo and then into a fetus in preparation for childbirth

The Human Life Cycle mainly consists of 9 stages. They are put simply; pregnancy, infancy and toddler years, childhood, puberty, adolescence, adulthood, middle age and old age.

It has been stated that as soon as you reach physical maturity, your body starts to age. I firmly believe this to be true. Scientists have been searching for the gene responsible for the aging process. If this gene is found, the life expectancy of the average person would increase substantially. I am not sure if this is a good thing, but I digress. Let us start this discussion of the human odyssey with the fertilization of the egg.

Life begins with the first trimester (weeks one to week twelve), extends into the second trimester (weeks thirteen to week twenty-seven), and ends with the third trimester (week twenty-eight to birth). At conception, a sperm cell fertilizes an egg cell, creating a zygote. The zygote rapidly divides into multiple cells and within two weeks becomes an embryo and implants itself in the uterine wall, where it develops into a fetus. Some of the major changes that occur include the branching of nerve cells to form primitive neural pathways at eight weeks. At the twenty-week mark, physicians typically perform an ultrasound to acquire information about the fetus and check for abnormalities. By this time, it is possible to know the sex of the baby. At twenty-eight weeks, the unborn baby begins to add body fat in preparation for life outside of the womb.

Throughout this entire process, a pregnant woman’s nutritional choices affect not only fetal development but also her own health and the future health of her newborn.

Since pregnancy is such a major component of life I have included the changes that a woman experiences during the three trimesters of pregnancy.

First Trimester
The first trimester of pregnancy is marked by an invisible — yet amazing — transformation. And it happens quickly. Knowing what physical and emotional changes to expect during the first trimester can help you face the months ahead with confidence.

Your body
While your first sign of pregnancy might have been a missed period, you can expect several other physical changes in the coming weeks, including:

Tender, swollen breasts. Soon after conception, hormonal changes might make your breasts sensitive or sore. The discomfort will likely decrease after a few weeks as your body adjusts to hormonal changes.

Nausea with or without vomiting. Morning sickness, which can strike at any time of the day or night, often begins one month after you become pregnant. This might be due to rising hormone levels. To help relieve nausea, avoid having an empty stomach. Eat slowly and in small amounts every one to two hours. Choose foods that are low in fat. Avoid foods or smells that make your nausea worse. Drink plenty of fluids. Foods containing ginger might help. Contact your health care provider if your nausea and vomiting is severe.

Increased urination. You might find yourself urinating more often than usual. The amount of blood in your body increases during pregnancy, causing your kidneys to process extra fluid that ends up in your bladder.

Fatigue. During early pregnancy, levels of the hormone progesterone soar — which can put you to sleep. Rest as much as you can. A healthy diet and exercise might increase your energy.

Food cravings and aversions. When you’re pregnant, you might become more sensitive to certain odors and your sense of taste might change. Like most other symptoms of pregnancy, food preferences can be chalked up to hormonal changes.
Heartburn. Pregnancy hormones relaxing the valve between your stomach and esophagus can allow stomach acid to leak into your esophagus, causing heartburn. To prevent heartburn, eat small, frequent meals and avoid fried foods, citrus fruits, chocolate, and spicy or fried foods.

Constipation. High levels of the hormone progesterone can slow the movement of food through your digestive system, causing constipation. Iron supplements can add to the problem. To prevent or relieve constipation, include plenty of fiber in your diet and drink lots of fluids, especially water and prune or other fruit juices. Regular physical activity also helps.

Your emotions
Pregnancy might leave you feeling delighted, anxious, exhilarated and exhausted — sometimes all at once. Even if you’re thrilled about being pregnant, a new baby adds emotional stress to your life.

It’s natural to worry about your baby’s health, your adjustment to parenthood and the financial demands of raising a child. If you’re working, you might worry about how to balance the demands of family and career. You might also experience mood swings. What you’re feeling is normal. Take care of yourself, and look to loved ones for understanding and encouragement. If your mood changes become severe or intense, consult your health care provider.

2nd Trimester

The second trimester of pregnancy often brings a renewed sense of well-being. The worst of the nausea has usually passed, and your baby isn’t big enough to make you too uncomfortable. Yet more pregnancy symptoms are on the horizon. Here’s what to expect.

Your body
During the second trimester of pregnancy, you might experience physical changes, including:

Growing belly and breasts. As your uterus expands to make room for the baby, your belly grows. Your breasts will also gradually continue to increase in size. A supportive bra with wide straps or a sports bra is a must.

Braxton Hicks contractions. You might feel these mild, irregular contractions as a slight tightness in your abdomen. They’re more likely to occur in the afternoon or evening, after physical activity or after sex. Contact your health care provider if the contractions become regular and steadily increase in strength. This could be a sign of preterm labor.

Skin changes. Hormonal changes during pregnancy stimulate an increase in pigment-bearing cells (melanin) in your skin. As a result, you might notice brown patches on your face (melasma). You might also see a dark line down your abdomen (linea nigra). These skin changes are common and usually fade after delivery. Sun exposure, however, can aggravate the issue. When you’re outdoors, use sunscreen. You might also notice reddish-brown, black, silver or purple lines along your abdomen, breasts, buttocks or thighs (stretch marks). Although stretch marks can’t be prevented, most eventually fade in intensity.

Nasal problems. During pregnancy, your hormone levels increase and your body makes more blood. This can cause your mucous membranes to swell and bleed easily, resulting in stuffiness and nosebleeds. Saline drops or a saline rinse can help relieve congestion. Also, drink plenty of fluids, use a humidifier, and dab petroleum jelly around the edges of your nostrils to help moisten skin.

Dental issues. Pregnancy can cause your gums to become more sensitive to flossing and brushing, resulting in minor bleeding. Rinsing with salt water and switching to a softer toothbrush can decrease irritation. Frequent vomiting could also affect your tooth enamel and make you more susceptible to cavities. Be sure to keep up your dental care during pregnancy.

Dizziness. Pregnancy causes changes in circulation that might leave you dizzy. If you’re having trouble with dizziness, drink plenty of fluids, avoid standing for long periods, and move slowly when you stand up or change position. When you feel dizzy, lie down on your side.

Leg cramps. Leg cramps are common as pregnancy progresses, often striking at night. To prevent them, stretch your calf muscles before bed, stay physically active, and drink plenty of fluids. Choose shoes with comfort, support and utility in mind. If a leg cramp strikes, stretch the calf muscle on the affected side. A hot shower, warm bath or ice massage also might help.

Vaginal discharge. You might notice a sticky, clear or white vaginal discharge. This is normal. Contact your health care provider if the discharge becomes strong smelling, unusual in color, or if it’s accompanied by pain, soreness or itching in your vaginal area. This could indicate a vaginal infection.

Urinary tract infections. These infections are common during pregnancy. Contact your health care provider if you have a strong urge to urinate that can’t be delayed, sharp pain when you urinate, urine that is cloudy or has a strong smell or you have a fever or backache. Left untreated, urinary tract infections can become severe and result in a kidney infection.

Your emotions
During the second trimester, you might feel less tired and more up to the challenge of preparing for your baby. Check into childbirth classes. Some childbirth classes may be available online. Find a doctor for your baby. Read about breastfeeding. If you will work after the baby is born, get familiar with your employer’s maternity leave policy and investigate child care options.

You might worry about labor, delivery or impending parenthood. To ease your anxiety, learn as much as you can. Focus on making healthy lifestyle choices that will give your baby the best start.

3rd Trimester

The third trimester of pregnancy can be physically and emotionally challenging. Your baby’s size and position might make it hard for you to get comfortable. You might be tired of pregnancy and eager to move on to the next stage. If you’ve been gearing up for your due date, you might be disappointed if it comes and goes uneventfully.

Try to remain positive as you look forward to the end of your pregnancy. Soon you’ll hold your baby in your arms! Here’s what to expect in the meantime.

Your body
As your pregnancy progresses, your baby’s movements will become more obvious. These exciting sensations are often accompanied by increasing discomfort and other signs and symptoms, including:

Braxton Hicks contractions. You might feel these mild, irregular contractions as a slight tightness in your abdomen. They’re more likely to occur in the afternoon or evening, after physical activity or after sex. These contractions also tend to occur more often and become stronger as you approach your due date. Contact your health care provider if the contractions become regular and steadily increase in strength.

Backaches. Pregnancy hormones relax the connective tissue that holds your bones in place, especially in the pelvic area. These changes can be tough on your back, and often result in discomfort during the third trimester of pregnancy. When you sit, choose chairs with good back support. Get regular exercise. Wear low-heeled — but not flat — shoes with good arch support. If you have severe or persistent pain, contact your health care provider.

Shortness of breath. You might get winded easily. Practice good posture to give your lungs more room to expand.

Heartburn. Pregnancy hormones relax the valve between your stomach and esophagus. This can allow stomach acid to reflux into your esophagus and cause heartburn. To prevent heartburn, eat small, frequent meals. Also, avoid fried foods, citrus fruits, chocolate, and spicy or fried foods.

Spider veins, varicose veins and hemorrhoids. Increased blood circulation might cause tiny red-purplish veins (spider veins) to appear on your face, neck and arms. Redness typically fades after delivery. You might also notice swollen veins (varicose veins) on your legs. Painful, itchy varicose veins in your rectal area (hemorrhoids) may also occur. To ease swelling, exercise and elevate your legs frequently, include plenty of fiber in your diet and drink lots of fluids. For hemorrhoid relief, soak in a warm tub or apply witch hazel pads to the area.
Frequent urination. As your baby moves deeper into your pelvis, you’ll feel more pressure on your bladder. You might find yourself urinating more often. This extra pressure might also cause you to leak urine — especially when you laugh, cough, sneeze, bend or lift. If this is a problem, consider using panty liners. If you think you might be leaking amniotic fluid, contact your health care provider.

Your emotions
As anticipation grows, fears about childbirth might become more persistent. How much will it hurt? How long will it last? How will I cope? If you haven’t done so already, consider taking childbirth classes. You’ll learn what to expect — and meet others who share your excitement and concerns. Talk with others who’ve had positive birth experiences, and ask your health care provider about options for pain relief.

The reality of parenthood might begin to sink in as well. You might feel anxious, especially if this is your first baby. To stay calm, write your thoughts in a journal. It’s also helpful to plan ahead. If you’ll be breast feeding, you might get a nursing bra or a breast pump. If you’re expecting a boy — or you don’t know your baby’s sex — think about what’s right for your family regarding circumcision.

10 Things That Might Surprise You About Being Pregnant

1. The Nesting Instinct
   Many pregnant women feel the nesting instinct, a powerful urge to prepare their home for the baby by cleaning and decorating.

As your due date draws closer, you may find yourself cleaning cupboards or washing walls — things you never would have imagined doing in your ninth month of pregnancy! This desire to prepare your home can be useful — you’ll have fewer to-do items after the birth. But be careful not to overdo it.

2. Problems With Concentration
   In the first trimester, tiredness and morning sickness can make many women feel worn out and mentally fuzzy. But even well-rested pregnant women may have trouble concentrating and periods of forgetfulness.

Thinking about the baby plays a role, as do hormonal changes. Everything — including work, bills, and doctor appointments — may seem less important than the baby and the coming birth. Making lists can help you remember dates and appointments.

3. Mood Swings
   Premenstrual syndrome and pregnancy are alike in many ways. Your breasts swell and become tender, your hormones go up and down, and you may feel moody. If you have PMS, you’re likely to have more severe mood swings during pregnancy. They can make you go from being happy one minute to feeling like crying the next.

Mood swings are very common during pregnancy. They tend to happen more in the first trimester and toward the end of the third trimester.

Many pregnant women have depression during pregnancy. If you have symptoms such as sleep problems, changes in eating habits, and mood swings for longer than 2 weeks, talk to your health care provider.

4. Bra Size
   An increase in breast size is one of the first signs of pregnancy. Breast growth in the first trimester is due to higher levels of the hormones estrogen and progesterone . That growth in the first trimester might not be the end, either — your breasts can continue to grow throughout your pregnancy!

Your bra size also can be affected by your ribcage. When you’re pregnant, your lung capacity increases so you can take in extra oxygen, which may lead to a bigger chest size. You may need to replace your bras several times during your pregnancy.

5. Skin Changes
   Do your friends say you have that pregnancy glow? It’s one of many effects that can come from hormonal changes and your skin stretching.

Pregnant women have increased blood volume to provide extra blood flow to the uterus and other organs, especially the kidneys. The greater volume brings more blood to the vessels and increases oil gland secretion.

Some women develop brownish or yellowish patches called chloasma, or the “mask of pregnancy,” on their faces. And some will notice a dark line on the midline of the lower abdomen, known as the linea nigra (or linea negra). They can also have hyperpigmentation (darkening of the skin) of the nipples, external genitalia, and anal region. That’s because pregnancy hormones cause the body to make more pigment.

This increased pigment might not be even, so the darkened skin may appear as splotches of color. Chloasma can’t be prevented, but wearing sunscreen and avoiding UV light can minimize its effects.

Acne is common during pregnancy because the skin’s sebaceous glands make more oil. And moles or freckles that you had before pregnancy may get bigger and darker. Most of these skin changes should go away after you give birth.

Many pregnant women also get heat rash, caused by dampness and sweating. In general, pregnancy can be an itchy time for a woman. Skin stretching over the abdomen may cause itchiness and flaking. Your doctor can recommend creams to soothe dry or itchy skin.

6. Hair and Nails
   Many women have changes in hair texture and growth during pregnancy. Hormones can make your hair grow faster and fall out less. But these hair changes usually aren’t permanent. Many women lose some hair in the postpartum period or after they stop breastfeeding.

Some women find that they grow hair in unwanted places, such as on the face or belly or around the nipples. Changes in hair texture can make hair drier or oilier. Some women even find their hair changing color.

Nails, like hair, can change during pregnancy. Extra hormones can make them grow faster and become stronger. Some women, though, find that their nails split and break more easily during pregnancy. Like the changes in hair, nail changes aren’t permanent. If your nails split and tear more easily when you’re pregnant, keep them trimmed and avoid the chemicals in nail polish and nail polish remover.

7. Shoe Size
   Even though you can’t fit into any of your pre-pregnancy clothes, you still have your shoes, right? Maybe — but maybe not. Extra fluid in their pregnant bodies mean that many women have swollen feet and need to wear a larger shoe size. Wearing slip-on shoes in a larger size can be more comfortable, especially in the summer months.
8. Joint Mobility
   During pregnancy, your body makes the hormone relaxin, which is believed to help prepare the pubic area and the cervix for the birth. Relaxin loosens the ligaments in your body, making you less stable and more at risk for injury. It’s easy to overstretch or strain yourself, especially the joints in your pelvis, lower back, and knees. When exercising or lifting objects, go slowly and avoid sudden, jerking movements.
9. Varicose Veins, Hemorrhoids, and Constipation
   Varicose veins, usually found in the legs and genital area, happen when blood pools in veins enlarged by pregnancy hormones. Varicose veins often go away after pregnancy. To help prevent them:

-avoid standing or sitting for long periods
-wear loose-fitting clothing
-wear support hose
-raise your feet when you sit

Hemorrhoids — varicose veins in the rectum — are common during pregnancy as well. Your blood volume has increased and your uterus puts pressure on your pelvis. So the veins in your rectum may enlarge into grape-like clusters. Hemorrhoids can be very painful, and can bleed, itch, or sting, especially during or after a bowel movement (BM).

Constipation is another common pregnancy woe. It happens because pregnancy hormones slow the passing of food through the gastrointestinal tract. During the later stages of pregnancy, your uterus may push against your large intestine, making it hard for you to have a BM. And constipation can contribute to hemorrhoids because straining to go may enlarge the veins of the rectum.

The best way to deal with constipation and hemorrhoids is to prevent them. Eating a fiber-rich diet, drinking plenty of liquids daily, and exercising regularly can help keep BMs regular. Stool softeners (not laxatives) may also help. If you do have hemorrhoids, talk to your health care provider about a cream or ointment that can shrink them.

10. Things That Come Out of Your Body During Labor
    So you’ve survived the mood swings and the hemorrhoids, and you think your surprises are over. But the day you give birth will probably hold the biggest surprises of all.

During pregnancy, fluid surrounds your baby in the amniotic sac. This sac breaks (or “ruptures”) at the start of or during labor — a moment usually referred to as your water breaking. For most women in labor, contractions start before their water breaks. Sometimes the doctor has to rupture the amniotic sac (if the cervix is already dilated).

How much water can you expect? For a full-term baby, there are about 2 to 3 cups of amniotic fluid. Some women may feel an intense urge to pee that leads to a gush of fluid when their water breaks. Others may only feel a trickling down their leg because the baby’s head acts like a stopper to prevent most of the fluid from leaking out.

Amniotic fluid is generally sweet-smelling and pale or colorless. It’s replaced by your body every 3 hours, so don’t be surprised if you continue to leak fluid, about a cup an hour, until delivery.

Other, unexpected things may come out of your body during labor. Some women have nausea and vomiting. Others have diarrhea before or during labor, and passing gas is also common. During the pushing phase of labor, you may lose control of your bladder or bowels.

A birth plan can help communicate your wishes to your health care providers about how to handle these and other aspects of labor and delivery.

Lots of surprises are in store for you when you’re pregnant — but none sweeter than the way you’ll feel once your newborn is in your arms!

References
med.libretexts.org, ‘ The Human Life Cycle.”; mayoclinic.org, “ Pregnancy week by week.”; kidshealth.org, “ 10 Things That Might Surprise You About Being Pregnant.” By Elana PearlBen-Joseph MD;

Chapter 2–Infancy
The earliest part of childhood. It is the period from birth to the acquisition of language approximately one to two years later.

The average newborn infant weighs 3.4 kg (7.5 pounds) and is about 51 cm (20 inches) long. The newborn gains weight at an average of 170 to 200 g (6 to 7 ounces) per week for the first three months. Growth continues, but the rate gradually declines to an average of 60 g per week after 12 months.

Newborns typically sleep for about 16–18 hours a day, but the total amount of time spent sleeping gradually decreases to about 9–12 hours a day by age two years. At birth infants display a set of inherited reflexes involving such acts as sucking, blinking, grasping, and limb withdrawal. Infants’ vision improves from 20/800 (in Snellen notation) among two-week-olds to 20/70 vision in five-month-olds to 20/20 at five years. Even newborns are sensitive to certain visual patterns, chiefly movement and light-dark contrasts and show a noticeable preference for gazing at the human face; by the first or second month they can discriminate between different faces, and by the third they can identify their mother by sight. Young infants also show a predilection for the tones of their mother’s voice, and they manifest a surprising sensitivity to the tones, rhythmic flow, and sounds that together make up human speech.

The infancy period is full of social development milestones. While lying they are able to lift and turn their heads. Vision is improved, able to track objects. Neck muscles are developed and they are able to sit with support with their head up.

Characteristics of Infancy
Characteristics of infancy, even though generalized, can also be very specific to each infants’ growth and development depending on their birth. Before birth, when they are still in their mother’s womb, they are referred to as a foetus.

A normal infant is the one where they are conceived by normal pregnancy and the female has experienced a very safe period during all the trimesters. The labor and delivery too when are normal, the infant is said to be a normal infant. Their characteristics and developmental stage are also normal and natural, unlike the infants who are prematurely born.

When the fetus is not confined to the normal duration of 36 weeks or 9 months of pregnancy and due to some unprecedented circumstances that can be related to the mother or the foetus being born before this period. Such newborns are called premature babies and they are put in an incubation set up in the hospital till they reach their normal infancy life-stage development.

Certain Common Characteristics are-
-They have a distinctive appearance with a large head and arms and legs relatively short.
-The infants have narrower shoulders and hips.
-They have a slightly protruding abdomen.
-Downy, unpigmented hair called lanugo is found in many newborns on many areas of their body except feet and palm. But within a few weeks after birth, this usually disappears.
-They may have a head full of hair to almost no hair.
-The navel is formed after a few weeks when the stub of the umbilical cord that still remains dries and falls off.

The ideal food for the young infant is human milk, though infant formula is an adequate substitute. Babies can usually be weaned after they are six months old, and the appearance of teeth allows them to switch from soft foods to coarser ones by the end of the first year. The first tooth usually erupts at about six months. By the end of the first year, six teeth usually have erupted—four upper incisors and two lower incisors.

Every normal, healthy infant proceeds through a sequence of motor development that occurs spontaneously and needs no special training. By four months of age the baby can reach for and grasp an object, and by the 10th month he can grasp a small object between thumb and forefinger. By four months most babies are able to sit up for a minute or so without support, and by nine months they can do so without support for 10 minutes or more. Most infants begin crawling between 7 and 10 months, and by 12 months they can stand up alone. The average baby is able to walk with help by 12 months and can walk unaided by 14 months, at which time he is often referred to as a toddler.

The infant’s understanding and mastery of the physical world begins with the reflex movements of newborns. These movements progress within three months to such actions as sucking, grasping, throwing, kicking, and banging, though these are purposeless and repeated for their own sake. During the 4th to the 8th month, the infant begins to repeat those actions that produce interesting effects, and from the 8th to the 12th month he begins coordinating his actions to attain an external goal—e.g., knocking down a pillow to obtain a toy hidden behind it. The infant’s physical actions thus begin to show greater intentionality, and he eventually begins to invent new actions in a form of trial-and-error experimentation. By the 18th month the child has begun trying to solve problems involving physical objects by mentally imagining certain events and outcomes, rather than by simple physical trial-and-error experimentation.

Infants display behavioral reactions suggestive of emotional states as early as the first three or four months of life. The four earliest emotional states they seem to experience are surprise, distress (in response to discomfort), relaxation, and excitement. New emotional states such as anxiety, fear, and sadness have appeared by one year of age. Infants’ central emotional feat, however, is probably the establishment of enduring emotional bonds with their parents or other caregivers. They are biologically predisposed to form such attachments, which in turn form the basis for healthy emotional and social development through childhood. It is through the reciprocal interactions between child and parent that the child learns to love, trust, and depend on other human beings. By two months of age, all normal infants show a social smile that invites adults to interact with them, and at about six months of age infants begin to respond socially to particular people to whom they have become emotionally attached.

Crying is basic to infants from birth, and the cooing sounds they have begun making by about eight weeks progress to babbling and ultimately become part of meaningful speech. Virtually all infants begin to comprehend some words several months before they themselves speak their first meaningful words. By 11 to 12 months of age they are producing clear consonant-vowel utterances such as “mama” or “dada.” The subsequent expansion of vocabulary and the acquisition of grammar and syntax mark the end of infancy and the beginning of child development.

Language
The capacity for language usually emerges in infants soon after the first birthday, and they make enormous progress in this area during their second year. Language is a symbolic form of communication that involves, on the one hand, the comprehension of words and sentences and, on the other, the expression of feelings, thoughts, and ideas. The basic units of language are phonemes, morphemes, and words. Phonemes are the basic sounds that are combined to make words; most languages have about 30 phonemes, which correspond roughly to the sounds of the spoken letters of the alphabet. Although one-month-old infants can discriminate among various phonemes, they are themselves unable to produce them. By 4 to 6 months of age, however, infants usually express vowellike elements in their vocalizations, and by 11–12 months of age they are producing clear consonant-vowel utterances like “dada” and “mama.”

Virtually all children begin to comprehend some words several months before they speak their own first meaningful words. In fact, one- to three-year-olds typically understand five times as many words as they actually use in everyday speech. The average infant speaks his first words by 12–14 months; these are generally simple labels for persons, objects, or actions; e.g., “mommy,” “milk,” “go,” “yes,” “no,” and “dog.” By the time the child reaches his 18th month, he has a speaking vocabulary of about 50 words. The single words he uses may stand for entire sentences. Thus, the word “eat” may signify “Can I eat now?” and “shoe” may mean “Take off my shoe.” The child soon begins to use two-word combinations for making simple requests or for describing the environment: “Want juice,” “Daddy gone,” “Mommy soup.” These simple statements are abbreviated versions of adult sentences. “Where is the ball?” becomes “where ball?”; the sentence “That’s the ball” becomes “that ball.” These early two-word combinations consist mostly of nouns, verbs, and a few adjectives. Articles (a, an, the), conjunctions (and, or, but), and prepositions (in, on, under) are almost completely absent at this stage. In their telegraphic sentences, children usually place the subject, object, and verb in an order that is correct within certain broad limits for their native language. For example, an American child will say “want ball” rather than “ball want” for a sentence meaning “I want the ball.”

In the few months before the child’s second birthday, there is a major increase in the size of his vocabulary and in the variety of his two- and three-word combinations. By two years of age a child’s comprehension vocabulary contains an average of about 270 words. By the end of the second year, he understands interrogatives such as “where,” “who,” and “what,” and by three years of age he can correctly interpret the respective use of the words “this” or “that” and “here” or “there,” as well as the terms “in front of” and “behind.” By three years of age children are learning at least two new words a day and possess a working vocabulary of 1,000 words.

Children in their second and third years sometimes use words as over extensions; “doggie,” for instance, may refer to a variety of four-legged animals as well as to dogs, and the word “daddy” may be used in reference to all men. This occurs simply because, although the infant detects the differences among various types of animals, he has only one word (“dog”) in his vocabulary to apply to them. Over extensions are more common in speech than in comprehension, however; the child who uses the word “apple” for all round objects has no difficulty pointing to an apple in a picture illustrating several round objects. Other words are under-extended; that is, they are defined too narrowly. Some infants will use the word “car” to refer only to cars moving on the street but not to cars standing still or to a picture of a car.

Children learn the rules of syntax (i.e., the grammatical rules specifying how words are combined in a sentence) with very little explicit instruction or tutoring from adults. They begin to flesh out their noun-verb sentences with less critical words such as prepositions, conjunctions, articles, and auxiliary verbs. Children follow a typical sequence in their acquisition of grammatical rules, depending on the language they are learning to use. In English, a child first masters the grammatical rules for the present tense (e.g., “I want”) and begins to use the present progressive ending (“-ing”) and the plural. This is followed by mastery of the irregular past tense (“I made,” “I had”), possessives (my, mine, his), articles (a, an, the), and the regular past tense (“I walked,” “he stopped”). These successes are followed by mastery of the third person present tense (“he goes”) and auxiliary verbs (“I’m walking,” “we’re playing”).

Deaf children learning sign language from deaf-mute parents show in their signs the same course of development that is apparent in the speech of children with normal hearing. Deaf, like hearing, children make their first signs for objects and later display signs for more complex ideas like “Mommy eat” or “Daddy coat.”

By the middle of the third year, children tend to use more sentences containing four, five, or six words, and by the fourth year they can converse in adultlike sentences. Finally, five- and six-year-olds demonstrate metalinguistic awareness—i.e., a mastery of the complex rules of grammar and meaning. They can differentiate between sounds that are real words and those that are not—e.g., they regard “apple” as a word but reject “oope” as a word. They can tell the difference between grammatically correct and incorrect sentences and will make spontaneous corrections in their speech; that is to say, if a child makes a speech error, he recognizes it and will say the phrase or sentence correctly the second time.

A major disagreement among theories of language acquisition is their relative emphasis on the role of maturation of the brain, on the one hand, and of social interaction, on the other. The most popular view assumes that biological factors provide a strong foundation for language acquisition but that infants’ social interaction with others is absolutely necessary if language is to develop. The special biological basis of language is supported by the fact that deaf children who are not exposed to a sign language invent a symbol system that is similar in structure to that developed by hearing children. But interaction with other people is also crucial. Even during the first year, children’s production and perception of speech sounds are increasingly shaped by the linguistic environment around them, reflecting their exquisite sensitivity and susceptibility to human speech. Indeed, the amount and variety of verbal stimulation is a critical factor in language development, as is the adult care-givers’ sensitivity to an infant’s own vocalizations; mothers who ask questions and encourage their infants’ vocal responses have children who show a more advanced language development.

Cognitive development
The mental activities involved in the acquisition, processing, organization, and use of knowledge are collectively termed cognition. These activities include selective attention, perception, discrimination, interpretation, classification, recall and recognition memory, evaluation, inference, and deduction. The cognitive structures that are involved in these processes include schemata, images, symbols, concepts or categories, and propositions. A schema is an abstract representation of the distinctive characteristics of an event. These representations are not photographic copies or visual images but are more like schematic blueprints that emphasize the arrangement of a set of salient elements, which supply the schema with distinctiveness and differentiate it from similar events. The child’s ability to recognize the face of another person is mediated by a schema, for example. Young children already display a remarkable ability to generate and store schemata. Another type of early cognitive unit is the image; this is a mental picture, or the reconstruction of a schema, that preserves the spatial and temporal detail of the event.

Symbols represent the next level of abstraction from experience; they are arbitrary names for things and qualities. Common examples of symbols are the names for objects, letters, and numbers. Whereas a schema or image represents a specific experience, such as a sight or sound, a symbol is an arbitrary representation of an event. The letter A is a symbol, and children use schemata, images, and symbols in their mastery of the alphabet. Symbols are used in the development of higher cognitive units called concepts. A concept, or category, may be thought of as a special kind of symbol that represents a set of attributes common to a group of symbols or images. The concept represents a common attribute or meaning from a diverse array of experiences, while a symbol stands for a particular class of events. Concepts are used to sort specific experiences into general rules or classes, and conceptual thinking refers to a person’s subjective manipulations of those abstract classes.

Jean Piaget tried to trace specific stages in children’s progressive use of symbols and concepts to manipulate their environment. According to Piaget, two of the four stages of cognitive development occur during childhood: the pre-operational stage (2 to 7 years), in which the child learns to manipulate the environment by means of symbolic thought and language; and the concrete-operational stage (7 to 12 years), in which the beginnings of logic appear in the form of classifications of ideas and an understanding of time and number. An important structure in Piaget’s theory of cognitive development is the operation, which is a cognitive structure that the child uses to transform, or “operate on,” information. Children learn to use operations that are flexible and fully reversible in thought; the ability to plan a series of moves in a game of checkers and then mentally retrace one’s steps to the beginning of that sequence is one such example of an operation.

It is important to make a distinction between the knowledge and skills a child possesses, called competence, and the demonstration of that knowledge in actual problem-solving situations, called performance. Children often possess knowledge that they do not use even when the occasion calls for it. Adapting to new challenges, according to Piaget, requires two complementary processes. The first, assimilation, is the relating of a new event or object to cognitive structures the child already possesses. A five-year-old who has a concept of a bird as a living thing with a beak and wings that flies will try to assimilate the initial perception of an ostrich to his concept of bird. Accommodation, the second process, occurs when the information presented does not fit the existing concept. Thus, once the child learns that the ostrich does not fly, he will accommodate to that fact and modify his concept of bird to include the fact that some birds do not fly.

One of the central victories of cognitive development occurs during ages five to seven and, according to Piaget, marks the child’s entry to the concrete-operational stage. This is the ability to reason simultaneously about the whole and about part of the whole. For instance, if an eight-year-old is shown eight yellow candies and four brown candies and asked, “Are there more yellow candies or more candies,” he will say that there are more candies, whereas a five-year-old is likely to respond incorrectly that there are more yellow candies.

A child who has reached the concrete-operational stage is able to solve several other new kinds of logical problems. For example, a five-year-old who is shown two balls of clay of the same size and shape will tell an adult that they have the same amount of clay, but, when the experimenter rolls one of the balls into a long but thin sausage, the five-year-old will tend to say that the untouched sphere has more clay in it than the sausage-shaped object does. A seven-year-old, however, shows what is called the ability to conserve; when presented with the same problem, he will recognize that the two pieces still have the same amount of clay in them, based on his awareness that liquids and solids do not change in amount or quantity merely because their external shape changes. The seven-year-old is able to reverse an event in thought and knows that the sausage can be reshaped back into the original ball without a loss or gain in the total amount of clay. The knowledge that one can reverse one state of affairs into a prior state, which is called conservation, is a mark of this new stage of development.

Another cognitive advance children make during the concrete-operational stage is the knowledge that hierarchical relationships can exist within categories. This is illustrated by the ability to arrange similar objects according to some quantified dimension, such as weight or size. This ability is called seriation. A seven-year-old can arrange eight sticks of different lengths in order from shortest to longest, indicating that the child appreciates a relation among the different sizes of the objects. Seriation is crucial to understanding the relations between numbers and hence to learning arithmetic. Children in the concrete-operational stage also appreciate the fact that terms such as taller, darker, and bigger refer to a relation between objects rather than to some absolute characteristic.

One implication of the stage of concrete operations is that the child is now able to compare himself with other children in such qualities as size, attractiveness, intelligence, courage, and so on. Hence, the formation of the child’s sense of identity, or self-concept, proceeds at a faster rate because he is able to compare his characteristics with those of other children.

The final stage of cognitive development, called the stage of formal operations, begins at about age 12 and characterizes the logical processes of adolescents and adults. A child who has reached this stage of logical thinking can reason about hypothetical events that are not necessarily in accord with his experience. He shows a willingness to think about possibilities, and he can analyze and evaluate events from a number of different possible perspectives. A second hallmark of the stage of formal operations is the systematic search for solutions. Faced with a novel problem, the adolescent is able to generate a number of possible means of solving it and then select the most logical, probable, or successful of his hypotheses. The formal thinking of adolescents and adults thus tends to be self-consciously deductive, rational, and systematic. Finally, adolescents typically begin to examine their own thinking and evaluate it while searching for inconsistencies and fallacies in their own beliefs and values concerning themselves, society, and nature.

Symbolic ability and imitation
Symbolic ability, which appears at about one year of age, can be observed when a child imaginatively treats an object as something other than it is—pretending a wooden block is a car or using a cup as a hat. By the middle of their second year, children impart new functions to objects; they may turn a doll upside down and pretend it is a salt shaker or try to use a wooden block as if it were a chair. Many three-year-olds are capable of simple metaphor and will play with two wooden balls of different size as if they were symbolic of a parent and a child. Children’s drawings also become symbolic during the second and third years and begin to contain forms that look like (or at least are intended to represent) animals, people, and various objects.

Imitation may be defined as behavior that selectively duplicates that of another person. Like symbolism, it is a basic capacity that is inherent in human nature. Infants engage in selective imitation by seven or eight months of age, and their imitations become more frequent and complex during the next two to three years. One-year-olds already imitate the gestures, speech sounds, and instrumental actions that they see performed by people around them. They also become capable of imitating an act some time after they have actually observed it; for example, one-year-olds may imitate an action they witnessed one day earlier. Children often imitate the instrumental behaviors of parents, like cleaning or feeding, but are less likely to imitate emotional expressions or parental behaviors that have no instrumental goal. Children are also more likely to imitate their parents than their siblings or characters they see on television.

Children imitate others for a variety of reasons. They are most likely to imitate those acts over which they feel some uncertainty regarding their ability to perform. If they are too uncertain, they will cry; if they are absolutely certain they can perform an act, they are less likely to imitate it. Children also imitate actions that win parental approval or attention or that enhance their similarity to other persons they want to be like (e.g., a boy imitating his father).

Memory
Memory, which is central to all cognitive processes, involves both the storage of traces of past experience and the retrieval of that stored information at a later time. It is useful to distinguish between short-term and long-term memory processes. Short-term, or working, memory may be defined as referring to traces available for a maximum of 30 seconds immediately after stimulation, but typically for a much shorter period. The ability to remember a phone number while redialing it is a good example of short-term memory. Long-term memory, or permanent memory, refers to stored information that is potentially available for relatively long periods of time, extending up to a lifetime.

Two-year-olds can usually hold in short-term memory only one or two independent units of information, while 15-year-olds can remember seven or eight units (numbers or words, for example). Both children and adults tend to perform much better when they have to recognize than when they have to recall, but this difference is most dramatic in young children. Thus, a four-year-old child can usually recognize almost all of 12 pictures he has seen but may be able to recall only 2 or 3 of them. A 10-year-old, by contrast, who recognizes the 12 pictures can also recall as many as 8 of them.

Besides improvements in capacity, older children demonstrate an increasing speed of recall and can search their memory for information more quickly. Another improvement in memory ability is selectivity. As they grow older, children become adept at choosing more important items to remember—i.e., at distinguishing fundamental from merely incidental information. In addition, older children acquire more efficient strategies for the coding, rehearsal, and retrieval of information that younger children do not possess. By eight or nine years of age, for example, most children know that it is easier to relearn a text passage than to learn it for the first time. Generally, older children are better able to plan their own behaviour, formulate problems, monitor their ability, control distraction and anxiety, and evaluate the quality of their cognitive products. And because older children have a more accurate understanding of their own abilities, they are better able to assess and predict the cognitive abilities of other people.

The makeup of intelligence
Controversy exists over whether children can be said to differ in a unitary abstract ability called intelligence or whether each child might better be described as possessing a set of specific cognitive abilities. Some children are especially proficient with verbal problems and less proficient at problems involving spatial relations or mathematical reasoning, for example. The American psychologist J.P. Guilford suggests that cognitive abilities can be classified along three dimensions: the content of the information (symbolic, semantic, behavioral, or figural); the operation performed on the content (memory, evaluation, convergence, divergence, or cognition); and finally the product of the cognitive work (a unit, a class, a relation, a system, a transformation, or an implication). This theory predicts that there are a very large number of different cognitive profiles, not just one.

Emotional and social development
Personality traits
Although earlier theorists believed that personality traits evident in the first three years of life would persist into later life, research indicates that this claim is exaggerated. Long-term studies that follow children from infancy through adolescence and into adulthood indicate that lasting personality traits do not emerge until after six or seven years of age and that most of the differences seen in children in the first three years of life are not preserved. The one possible exception to this claim holds for the temperamental qualities of inhibited and uninhibited to the unfamiliar. Children who are extremely inhibited or uninhibited in the first three years of life are more likely than others to retain those qualities through late childhood.

Self-awareness and empathy
Perhaps the most important aspect of children’s emotional development is a growing awareness of their own emotional states and the ability to discern and interpret the emotions of others. The last half of the second year is a time when children start becoming aware of their own emotional states, characteristics, abilities, and potential for action; this phenomenon is called self-awareness. Two-year-old children begin to describe their own actions as they are performing them, can recognize a reflection of themselves in the mirror, and may become possessive with their toys for the first time. This growing awareness of and ability to recall one’s own emotional states leads to empathy, or the ability to appreciate the feelings and perceptions of others. Young children’s dawning awareness of their own potential for action inspires them to try to direct (or otherwise affect) the behaviour of others. This change is often accompanied by the urge to test the standards of behavior held by parents, and, as a result, children’s second and third years are often called the “terrible twos.”

With age, children acquire the ability to understand the perspective, or point of view, of other people, a development that is closely linked with the empathic sharing of others’ emotions. Even six-year-olds are aware that other people have different perspectives, thoughts, and feelings from their own, and they are able to empathize with the characteristics they observe in others. By eight to nine years of age a child recognizes that people can become aware of others’ point of view, and he likewise knows that others can become aware of his own perspective. By 10 years of age the child can consider a social interaction simultaneously from his own point of view and from that of another person. Owing to this increased awareness, children from age seven on are more conscious of what others think of them and show more concern over others’ opinion of their behavior. Finally, older children understand that a person’s genuine emotions can be stronger or different from those he actually reveals, and they thus appreciate that a person can disguise his emotions.

One major factor underlying these changes is the child’s increasing cognitive sophistication. For example, in order to feel the emotion of guilt, a child must appreciate the fact that he could have inhibited a particular action of his that violated a moral standard. The awareness that one can impose a restraint on one’s own behavior requires a certain level of cognitive maturation, and, therefore, the emotion of guilt cannot appear until that competence is attained.

A moral sense
Empathy and other forms of social awareness are important in the development of a moral sense. Morality embraces a person’s beliefs about the appropriateness or goodness of what he does, thinks, or feels. During the last few months of the second year, children develop an appreciation of right and wrong; these representations are called moral standards. Children show a concern over dirty hands, torn clothes, and broken cups, suggesting that they appreciate that certain events violate adult standards. By age two most children display mild distress if they cannot meet standards of behavior imposed by others. After age two they will playfully violate rules on acceptable behavior in order to test the validity of that standard. One of the signs of the child’s growing morality is the ability to control behaviour and the willingness to postpone immediate gratification of a desire.

Childhood is thus the time at which moral standards begin to develop in a process that often extends well into adulthood. The American psychologist Lawrence Kohlberg hypothesized that people’s development of moral standards passes through stages that can be grouped into three moral levels. At the early level, that of pre-conventional moral reasoning, the child uses external and physical events (such as pleasure or pain) as the source for decisions about moral rightness or wrongness; his standards are based strictly on what will avoid punishment or bring pleasure. At the intermediate level, that of conventional moral reasoning, the child or adolescent views moral standards as a way of maintaining the approval of authority figures, chiefly his parents, and acts in accordance with their precepts. Moral standards at this level are held to rest on a positive evaluation of authority, rather than on a simple fear of punishment. At the third level, that of post-conventional moral reasoning, the adult bases his moral standards on principles that he himself has evaluated and that he accepts as inherently valid, regardless of society’s opinion. He is aware of the arbitrary, subjective nature of social standards and rules, which he regards as relative rather than absolute in authority.

Thus the bases for justifying moral standards pass from avoidance of punishment to avoidance of adult disapproval and rejection to avoidance of internal guilt and self-recrimination. The person’s moral reasoning also moves toward increasingly greater social scope (i.e., including more people and institutions) and greater abstraction (i.e., from reasoning about physical events such as pain or pleasure to reasoning about values, rights, and implicit contracts). This transition from one stage to another is characterized by gradual shifts in the most frequent type of reasoning; thus, at any given point in life, a person may function at more than one stage at the same time. Different people pass through the stages at varying rates. Finally, different people are likely to reach different levels of moral thinking in their lives, raising the possibility that some people may never reach the later, more abstract, stages.

The evidence for these theoretical stages comes from children’s answers to moral dilemmas verbally presented to them by researchers, rather than their actual behavior in time of conflict. Scientists have argued that many children display a more profound moral understanding than is evident in their responses on such tests. Others have argued that because even rather young children are capable of showing empathy with the pain of others, the inhibition of aggressive behavior arises from this moral affect rather than from the mere anticipation of punishment. Some scientists have found that children differ in their individual capacity for empathy, and, therefore, some children are more sensitive to moral prohibitions than others. There is evidence suggesting that temperamentally inhibited children whose parents impose consistent socialization demands on them experience moral affect more intensely than do other children.

Self-concept, or identity
One of the most important aspects of a child’s emotional development is the formation of his self-concept, or identity—namely, his sense of who he is and what his relation to other people is. The most conspicuous trend in children’s growing self-awareness is a shift from concrete physical attributes to more abstract characteristics. This shift is apparent in those characteristics children emphasize when asked to describe themselves. Young children—four to six years of age—seem to define themselves in terms of such observable characteristics as hair color, height, or their favorite activities. But within a few years, their descriptions of themselves shift to more abstract, internal, or psychological qualities, including their competencies and skills relative to those of others. Thus, as children approach adolescence, they tend to increasingly define themselves by the unique and individual quality of their feelings, thoughts, and beliefs rather than simply by external characteristics.

One of the earliest and most basic categories of self to emerge during childhood is based on gender and is called sex-role identity. Children develop a rudimentary gender identity by age three, having learned to classify themselves and others as either males or females. They also come to prefer the activities and roles traditionally assigned to their own sex; as early as two years of age, most children select toys and activities that fit the sex-role stereotypes of their culture, and during the preschool years they begin to select same-sex playmates. Another component of a child’s self-concept concerns the racial, ethnic, or religious group of which he is a part. A child who is a member of a distinctive or specific group has usually created a mental category for that group by five to six years, and children from ethnic minorities tend to be more aware of ethnic differences than are non-minority children.

One of the important processes that mediates a child’s self-concept is that of identification; this involves the child’s incorporation of the characteristics of parents or other persons by adopting their appearance, attitudes, and behavior. Children tend to identify with those persons to whom they are emotionally attached and whom they perceive to be similar to themselves in some way. They seem to identify most strongly with parents who are emotionally warm or who are dominant and powerful. The role models children adopt may have negative as well as positive characteristics, however, and can thus influence children in undesirable as well as beneficial ways.

More than 80 percent of American children have one or more sisters or brothers, and the presence of these siblings can influence a child’s personality development. Parents tend to be more involved and attentive toward the firstborn, stimulating him more (in the absence of other children) but then expecting and demanding more from him (as their oldest child). Because of this, firstborns tend to identify more closely with their parents, conform more closely to their values and expectations, and generally identify more closely with authority than do their younger siblings. Firstborns tend to be more strongly motivated toward school achievement, are more conscientious, more prone to guilt feelings, and less aggressive than those born later. A high proportion of eminent scientists and scholars have been firstborns, perhaps owing to the aforementioned traits, but firstborns also tend to be less receptive to ideas that challenge a popular ideological or theoretical position.

Peer socialization
During the first two years of life, infants do not spontaneously seek out other children for interaction or for pleasure. Although six-month-old infants may look at and vocalize to other infants, they do not initiate reciprocal social play with them. However, between two and five years of age, children’s interactions with each other become more sustained, social, and complex. Solitary or parallel play is dominant among three-year-olds, but this strategy shifts to group play by five years.

Problems in development
An estimated 6–10 percent of all children develop serious emotional or personality problems at some point. These problems tend to fall into two groups: those characterized by symptoms of extreme anxiety, withdrawal, and fearfulness, on the one hand, and by disobedience, aggression, and destruction of property on the other. The former set is called internalizing; the latter is termed externalizing. As indicated earlier, some fearful, timid, socially withdrawn children inherit a temperamental predisposition to develop this form of behavior; other children, however, acquire it as a result of a stressful upbringing, experiences, or social circumstances.

Sex-linked differences in aggression are evident from about two or three years of age, with boys being more aggressive than girls. Although young children sometimes fight and quarrel, usually over possessions, such behavior is generally not a serious problem in the first three or four years of life. Aggressive behavior can become a serious problem in older children, however, and by seven years of age a small proportion of boys do display an extreme and consistent tendency to be aggressive with others. Children who are highly aggressive by age seven or eight tend to remain so later in life; these children are three times more likely to have police records as adults than are other children. By age 30 significantly more members of this group had been convicted of criminal behavior, were aggressive with their spouses, and abused or severely punished their own children. Although biological factors can play a role in producing extreme aggression, the role of the child’s social environment is critical. Parents’ use of extreme levels of physical punishment, imposed inconsistently, is associated with high levels of aggression in children, as are extreme levels of parental permissiveness toward a child’s own aggressive acts. Psychologists frequently help parents deal with aggressive children by teaching them to observe what they do and to enforce rules consistently with their children. Parents can thereby learn effective but non-punitive ways of controlling their aggressive children.

Although precise information is difficult to obtain, it is estimated that each year about one million children in the United States are abused by their parents or other adults. Child abuse is more common in economically disadvantaged families than in affluent ones but occurs in all social classes, races, and ethnic groups. The abuse of children is often part of a pattern of family violence that is transmitted from parent to child for generations. Children who were abused as infants tend to show much more avoidance, resistance, and noncompliant behavior than do other children.

What are the Safety Measures To Consider During the Infancy Stage?
It is very important to ensure complete safety during the infancy stage for the proper growth and development of the infant. The key safety tips related to infants that everyone should ensure are

1. Keep the household cleaners, cosmetics, medicines, and even some plants present in your home away from infants in drawer and cupboard safety latches they contain poison. Keep the national poison control number — 1-800-222-1222 — near the phone.
2. The infants should not be allowed to crawl or walk around in the kitchen when others are cooking, though they can be placed near the kitchen in a highchair, playpen, or crib.
3. Drinking or carrying anything hot while you holding an infant can be dangerous because infants can burn them as they start waving their arms and grabbing for objects at 3 to 5 months.
4. Never leave an infant alone with siblings or pets because even older siblings may not be ready to handle an emergency if it occurs and pets, because pets may appear to be gentle and loving but they can react unexpectedly to an infant’s cries or grabs or may lie too close to the infant, thereby smothering the baby..
5. Never leave an infant at a place from where the child can fall off due to wiggle or rollover.
6. For the first 5 months of life, place your infant on their back to go to sleep as it reduces the risk for sudden infant death syndrome (SIDS). The risk of SIDS decreases as the nervous system matures and the baby can roll over by himself.
7. You can take a course or learn from your doctor how to handle a choking emergency in an infant.
8. Try not to leave small objects within the reach of an infant because infants tend to reach out to the items placed around them and put everything they can get their hands on into their mouth.
9. During a car ride, always remember to place your infant in a proper car seat even if you are riding for a very short distance. Use a car seat that faces backward until the infant is at least 1 year and then you can safely switch to a forward-facing car seat.
10. The middle of the back seat is the safest place for the infant’s car seat.
11. Be very careful while you are driving. Whenever you need to tend to the infant, park your car on the side before trying to help the child.
12. Use gates on stairways, and block off rooms that are not “childproof.” Remember, infants may learn to crawl or scoot as early as 6 months.

Do’s and Don’ts for the Infants
Do’s-

-Accept help from others like a family member or a nanny if you can afford one. Do not succumb to the pressure of others to do all of it on your own and go at your own pace.

-Always clean your hands before holding the baby and politely ask others who come near your baby to do the same.

-Try to bond with your infant by talking to them, playing music, any activity that you participate in enthusiastically, it will strengthen your bond.

-When holding, always provide support in the neck till they learn to do it on their own.

-Mothers must keep the infant close to their body to provide comfort and soothe when necessary.

-The mother-child relationship and connection are such that even proximity can do wonders, so try to stay near the infant as much as possible.

-Whenever travelling, see that the infant is well-fastened and protected from all possible dangers.

-Learn all the basics of bathing, cleansing, changing diapers, feeding and burping needs.

Don’t-

-Do not leave the baby crying, even if it is normal for the baby at the infancy stage to do so, try to swaddle gently.

-Do not underestimate the power of immunization and vaccination, do not go for it, without proper research and any allergic reaction to the vaccine must be noted and informed.

-Do not throw the baby in the air with the intention of playing when the infant is not developed enough to hold themselves steadily.

-Do not shake your baby in frustration or while playing.

-Do not drive fast with an infant, or even when in a stroller, they must be well protected, any rough motion can have serious consequences.

-Do not force-feed the infant when they are not willing to complete the bottle’s milk and take it as a sign of satiating hunger.

-Do not indulge in any negative patterns like fighting, frustration, anger as they can sense the energy in the room and their moods also change accordingly.

-Do not smoke near the baby, they must be only exposed to clean and fresh air.

Conclusion
The infancy stage is so crucial and one of the most important and even quick stages of developments. Often parents say infants develop so fast they must cherish the moments and enjoy the process. They are learning something new every day that also changes the perception of the parents and they too start noticing things in a new manner. Infants must be cared for with love, nutrition and attention and should not be limited to anything that restricts their growth.

References
Britannica.com, “Infancy.” By Britannica Editors; Britannica.com, “Development in childhood.” By Britannica Editors; vedantu.com, “infancy.”;

Chapter 3–Toddler
This stage occurs during ages two and three and are the end of early childhood.

By the age of 2, your toddler is talking, walking, climbing, jumping, running and bustling with energy. Your child now has a growing vocabulary and acquires new words on a regular basis. She/he can sort shapes and colors and may even show an interest in potty training. As your little one grows more independent, she/he may show signs of defiance as she/he begins to push boundaries and explore the world around her/him.

Social and emotional milestones at 2 years
Some of the ways you’ll see your little one learning to connect with the people around him at 2 years:
-Likes to copy adults and other children.
-Gets excited when he’s with other children.
-He is more independent, even more defiant.

Babies learn fast. In no time they can smile and roll over, walk and talk, draw, and even make friends. As they grow, they pick up all sorts of abilities in different areas.

Their motor, cognitive, social, and emotional skills begin to develop as soon as they’re born. Like pieces of a puzzle, these four major areas come together to form a whole known as “global development.”

For healthy development, a child’s physical needs (e.g., food, sleep, safety) and emotional needs must be met. “Children need to feel loved and cherished by their parents. When they’re upset, they need to be comforted. These emotional building blocks allow them to develop self-confidence and self-esteem, which helps them learn,” says Caroline Roussel, a psychoeducator for the early stimulation programs at the CIUSSS du Nord-de-l’Île-de-Montréal.

A stimulating environment is also key. “For their brains to activate, children need to explore their surroundings, interact with other kids, go outside, play, and try new things,” says Miriam Beauchamp, director of the ABCs Developmental Neuropsychology Lab at the University of Montreal and a researcher at the CHU Sainte-Justine Research Center.

Each at their own pace
No two kids are alike. One might start walking at 10 months, and another at 15 months. Some might say their first words before taking their first steps, while others do the opposite. A good rule of thumb is to not compare your child to others.

“All children develop at their own pace, depending on their genetic makeup, personality, and preferences,” says Beauchamp. “Their level of stimulation is also an important influence. A child who receives a lot of language stimulation, for example, might start speaking earlier.”

It’s important to consider your child’s abilities when setting the bar. “When children feels pressured or unable to meet expectations, they can develop anxiety and believe that they’re not worthy of being loved,” explains Roussel. “They can withdraw or even regress.”

Four major areas
As the months pass, your child will begin to reach physical, cognitive, emotional, and social milestones.

Children don’t always master the same skills at the same age, but they do go through the same developmental stages. “Children progress in a predictable sequence. They start simple, then move on to more complex tasks. Before taking their first steps, for instance, they learn how to creep, crawl, and stand upright,” explains Miriam Beauchamp, director of the ABCs Developmental Neuropsychology Lab.

Motor development
Motor development includes gross and fine motor skills.

Gross motor skills are big movements, like crawling, walking, running, and rolling over, that require the use of larger muscles. “My nine-month-old, Loïk, can stand upright while holding on to furniture,” says Emanuelle Roy-Paradis, who also has two other children named Caleb and Alicia with her partner, Cécilia Moreno-Rivera. “He bounces whenever he hears a song in Spanish, Cécilia’s native language. He can also take a few steps with the help of his walker toy.”

Early on, babies figure out how to use their neck muscles to turn, lift, and hold up their head. Eventually they learn how to roll over, sit up, creep, crawl, walk, go up stairs, climb, jump, run, balance on one foot, pedal, and more.

“As children grow, their balance, coordination, and agility improve,” says Beauchamp. “This allows them to master more difficult movements, like kicking a ball while running.”

Fine motor skills are more precise movements that use the small muscles of the hands and fingers. “Our son Émile is four and a half and can zip up his own coat,” say Sophie Lalancette and Charles Langlois, who also have a six-year-old son. “He’s very handy with scissors. Once, he even made himself a mask.” However, Émile still can’t tie his shoelaces, a skill that children generally acquire at age five or six.

Children learn more precise movements as they develop hand-eye coordination and the ability to use both hands independently. For example, they can pick up different objects, give high-fives, point, flip the pages of a book, thread beads, hold a pencil, and unscrew a lid.

Cognitive development
From birth, babies are already developing cognitive abilities such as thinking, memory, attention, reasoning, and planning. These skills allow them to learn, solve problems, exercise judgment, and understand their surroundings. Language is also an important part of a child’s cognitive development.

During their first year, babies discover the notion of cause and effect through their random actions. “For example, your baby might shake a noisy rattle and realize that this action is causing a reaction,” explains Beauchamp. “Your child will shake the rattle again to recreate that noise. It’s the beginning of reasoning.” After age one, babies start to develop object permanence, the understanding that objects and people continue to exist even when they can’t be seen.

In terms of language acquisition, babies start by cooing (vowel sounds like “ahhh” and “ohhh”), then transition to babbling (syllables like “ba ba ba” and “pa pa pa”). By 12 to 16 months, they understand that words have meaning and start to speak.

Symbolic thinking develops between 18 months and three years. At this stage, children are able to represent objects and people in their minds. They can do puzzles and solve other small problems. They also start to play make-believe. Emanuelle and Cécilia’s three-year-old daughter Alicia loves this game. “She often pretends that she’s cooking or fixing things. She also loves dinosaurs and has an imaginary dinosaur friend who sleeps in the basement.”

Between ages three and five, children’s creativity and reasoning abilities improve drastically. For example, they can use logical reasoning to understand that a smaller box contains less than a bigger box. “I’m pregnant, and my partner has nicknamed me Mama Whale,” says Alexandra Loembe, mother of three-year-old Noah. “The other day, my son made a very logical connection and called his dad Papa Whale. We had a good laugh!”

Noah is also starting to grasp rules. “I taught Noah about traffic signals and told him to always wait for the green light before crossing the street,” says his father, William Longmene. “Now, he’s the one who reminds me to wait for the light to change!”

A four- or five-year-old can carry on a conversation, even if they make mistakes. “People understand Émile when he speaks,” says Sophie. “But he still mixes up time-related words, like ‘yesterday’ and ‘tomorrow.’”

Emotional development
According to Beauchamp, emotional development is essential for children to learn how to express themselves, recognize and control their emotions, and decipher the emotions of others. “This is the foundation on which all future relationships are built,” she says.

Your baby’s emotional development begins with the bond you share. It is through the parent-child relationship that babies develop a sense of security and confidence.

During their first few months of life, they might be fearful of strangers. “Whenever Loïk meets someone new, he runs up to Cécilia and hides,” says Emanuelle. But this fear doesn’t last. Thanks to the emotional security provided by their parents, children eventually open up to others. They develop a need to explore and be autonomous. Plus, they learn how to be empathetic, compassionate, resilient, and assertive.

Emotional development plays a central role in self-discovery, relationship building, self-confidence, and, eventually, academic success. That’s why it’s important for parents to interact with their children, allow them to make choices, and help them manage their emotions and understand the emotions of others.

Social development
For children to build relationships and live with others in society, their social development is key. They need social skills to make friends, get along with others, and be part of a team. “Most of our day-to-day activities require interacting with others,” points out Beauchamp.

“Family is the first place where children learn to socialize.” A child’s first interactions are the looks and smiles shared with his or her parents. Once children start spending time with other kids and adults, their social skills improve.

But they will not intuitively know how to share, wait their turn, be polite, lend a hand, collaborate, follow rules, make compromises, or resolve conflicts. These behaviours need to be learned. “When Noah’s friends come over to play, he still has trouble sharing certain toys,” says Alexandra. “But I’ve noticed that he’s better at sharing and cooperating when he’s with his friend Emma, who is a year older. For example, they take turns pushing each other when they play with his toy car.”

How to stimulate your child
Every day, you support your child’s development through countless tiny gestures.

“Every moment you spend with your child is an opportunity for stimulation,” says Caroline Roussel, a psychoeducator for the early stimulation programs at the CIUSSS du Nord-de-l’Île-de-Montréal. “For example, when you dress your baby, you can point out and name items of clothing and body parts to promote language development.” These interactions also spark young children’s emotional and social development.

Something as simple as baking a cake with your child can have a profound impact. This type of activity stimulates every area of your child’s development: motor skills (when pouring and mixing ingredients), cognitive ability (when following the steps and focusing on the task), emotional development (as the child-parent bond deepens and your child’s confidence grows), and social development (when working with you to accomplish the task).

It’s never too early to stimulate your baby. As soon as they’re born, they’re ready to learn! “The brain is at the center of learning and growth,” explains Miriam Beauchamp, director of the ABCs Developmental Neuropsychology Lab at the University of Montreal and a researcher at the CHU Sainte-Justine Research Center. “A baby’s brain develops most during the first years of life.”

Five winning attitudes to support your child’s development
SEE THE WORLD THROUGH A CHILD’S EYES
For your little one, every moment is an opportunity to learn and discover. “When you take your child to the park, it’s a chance to be outside, run, climb, play in the sand, and have fun with other kids,” says Beauchamp. “There’s so much to see, do, and experience.” Encourage your child to observe his or her surroundings. Point out a passing dog, colorful flowers, a plane in the sky, or the silky grass.

ENCOURAGE REAL-WORLD EXPERIENCES
Psychoeducator Caroline Roussel recommends that parents limit their child’s exposure to electronic screens as much as possible. “For a baby with so much to learn, devices can’t compare to real-life experiences such as interacting with others, touching objects, physically moving, and exploring the world with all five senses.”

SUPPORT IMAGINATIVE PLAY
Roussel also believes that children should be encouraged to take the reins and make decisions during playtime. “Follow them into their imaginary world. Not only will it be a fun bonding experience, but you’ll also boost their sense of autonomy, confidence, and creativity.”

ACKNOWLEDGE THEIR EFFORTS
While it’s good to congratulate children when they succeed, it’s equally important to praise their efforts. “Even if they can’t manage to put on their own pants, you can still commend them for trying,” says Roussel. “You’ll make them feel valued, and they’ll be eager to try again.”

CHOOSE THE RIGHT ACTIVITIES
There’s no point in trying to teach your child a skill that’s beyond his or her abilities. “Instead of pushing, offer support while letting your child develop at his or her own pace,” suggests Roussel. “You’ll both feel less pressured and have more fun.” For example, let your little one scribble instead of insisting that they draw shapes or letters that are too difficult.

Language and communication milestones at 2 years
How your toddler is expressing her needs:
-Says short sentences with two to four words.
-Points to things when they are named.
-Knows familiar body parts.
-Recognizes familiar people.
-Repeats words she has overheard and follows simple instructions.

Brain development milestones at 2 years
How your child’s brain is growing:
-Starts to sort shapes and colors.
-Can find things hidden under multiple layers.
–Completes sentences in familiar books.
Plays simple make-believe games.
-Builds towers with four or more blocks.
-Can follow two-step instructions.
-May start to develop a dominant hand.

Movement and physical development milestones at 2 years
How she’ll move through her environment:
-Can run, kick a ball and throw a ball overhead.
-Is starting to run.
-Climbs up and down from furniture without assistance.
-Makes or copies straight lines and circles.

Food and nutrition milestones at 2 years
What mealtimes look like at 2 years:
-Chews with full jaw movements.
-Uses utensils with some spills.

Things to look out for
While all children develop differently, you should speak to your paediatrician if your 2-year-old:
-Doesn’t know how to use common objects.
-Doesn’t use two-word phrases.
-Doesn’t copy actions or repeat words.
-Doesn’t follow basic directions.
-Can’t walk steadily.
-Loses skills she once had.

Erikson’s Theory of Psychosocial Development – Stage 2 (Toddler)

Erikson assumes that a psychosocial crisis occurs at each stage of development. Erikson believes psychological needs of an individual conflict with the needs of society. Erikson believes a toddler must form a sense of autonomy as they grow physically and begin to become more mobile. Erikson’s second stage of psychosocial development occurs during the first 1-3 years of life.

BASIC CONFLICT
Autonomy vs. Shame and Doubt
Auto vs. Bag-of-shame
Erikson believes that all toddlers must assert a sense of independence and autonomy. This is achieved when toddlers walk away from their caregivers, picking out what toys they play with, and choosing what they want to wear and eat. Erikson believes it is critical to allow children to explore the limits of their abilities within an encouraging environment. Instead of putting on a child’s clothes, a parent should be supportive, have patience, and allow the child to try to do things, such as dress themselves. This also allows children to learn how to ask for help when they need it.

IMPORTANT EVENTS
Toilet Training
Toilet-training Toilets
Erikson believes how a child is toilet trained and how they view this experience helps shape how they approach the world. He believes successful toilet training helps a child develop willpower, and helps teach them to know the difference between holding on and letting go.

VIRTUE
Will
Will-and-testament
If a sense of autonomy is developed, a toddler can have a sense of independence or own personal will. If the virtue of will is achieved, when a toddler is faced with new challenges in life, there will be a good possibility that the child will feel they can handle them autonomously, and have the determination to tackle them.

FREUD STAGE
Anal
Anal-anus
Freud’s psychosexual stage during toddlerhood that parallels Erikson’s psychosocial “autonomy vs. shame and doubt” stage, is the anal stage. The anal stage has to do with toilet training, specifically anus/bowel and bladder control and the pleasure it brings the child to defecate/urinate, and the control they have over these actions. He believes early or harsh potty training can lead to the child developing an anal-retentive personality; a person who is is obsessively clean and tidy, who hates messes, and is punctual and respectful of authority. This is thought to be because they got pleasure from retaining their feces as toddlers, where their caregivers were insisting they defecate by placing them back on the toilet. On the contrary, a person who had a more liberal potty training experience can develop into someone who is anal expulsive. This is a person who likes giving things away, who likes sharing things, and who is messy, disorganized and rebellious.

Even though Erikson’s Theory of Human Development has fallen out of vogue since he first published eight-stage theory of human development in 1950, it was very popular for many years. So in an effort to be complete I decided to at least give some time and explain how affects the toddler stage of development.

Developmental Delay

A developmental delay refers to a child who has not gained the developmental skills expected of him or her, compared to others of the same age. Delays may occur in the areas of motor function, speech and language, cognitive, play, and social skills. Global developmental delay means a young child has significant delays in two or more of these areas of development.

Causes of Developmental Delay
There is not one cause for delays in development. Factors that may contribute can occur before a child is born, during the birth process, and after birth. These could include:
-Genetic or hereditary conditions like Down syndrome
-Metabolic disorders like phenylketonuria (PKU)
-Trauma to the brain, such as shaken baby syndrome
-Severe psychosocial trauma, such as post-traumatic stress disorder
-Exposure to certain toxic substances like prenatal alcohol exposure or lead poisoning
-Some very serious infections
-Deprivation of food or environment
In some cases, it may not be possible to find the cause of the developmental delay.

Signs and Symptoms of Developmental Delay
There are many different signs and symptoms of delay that can exist in children and often vary depending upon specific characteristics. Sometimes you may see signs in infancy, but in other cases they may not be noticeable until your child reaches school age. Some of the most common symptoms can include:
-Learning and developing more slowly than other children same age
-Rolling over, sitting up, crawling, or walking much later than developmentally appropriate
-Difficulty communicating or socializing with others
-Lower than average scores on IQ tests
-Difficulties talking or talking late
-Having problems remembering things
-Inability to connect actions with consequences
-Difficulty with problem-solving or logical thinking
-Trouble learning in school
-Inability to do everyday tasks like getting dressed or using the restroom without help
-If there is an underlying medical reason that causes the developmental delay, identification and treatment of that condition may improve your child’s developmental skills.

Therapies for Developmental Delays
Although there is no cure for developmental delay, therapies directed to the specific area of delay are very effective in helping children catch up to their peers. These types of therapies may include:

Physical Therapy
Physical therapy is often helpful for children with delays in gross motor skills.

Occupational Therapy
This can addresses fine motor skills, sensory processing and self-help issues.

Speech and Language Therapy
Speech therapy is typically used to address problems in the areas of understanding and producing language and speech sounds.

Early Childhood Special Education
Early childhood special education provides stimulation for early developmental skills, including play skills.

Behavioral therapy
This may be needed in some children for behavioral difficulties that affect socially appropriate behaviors.

References
naitreetgrandir.com, “Your child’s development, step by step.” By Nathalie Vallerand; unicef.org, “Your toddler’s developmental milestones at 2 years.”; picmonic.com, “Master Erikson’s Theory of Psychosocial Development – Stage 2 (Toddler) with Picmonic for Nursing RN.”; ssmhealth.com, “Developmental Delay.”;

Chapter 4–Childhood
Takes place from ages four to eight.

For the sake of discussion we will break the childhood stage into two subgroups. The first subgroup will be ages 4 to 5 or preschooler ages and the second subgroup will be ages 6 to 8 or middle childhood.

The Preschool Ages

What can my 4- to 5-year-old child do at this age?
As your child continues to grow, you will notice new and exciting abilities that your child develops. While children may progress at different rates, the following are some of the common milestones children may reach in this age group:

4-year-olds:
-Sing songs
-Skip and hop on one foot
-Catch and throw a ball overhand
-Walk downstairs alone
-Draw a person with three separate body parts
-Build a block tower with 10 blocks
-Understand the difference between fantasy and reality
-Draw a circle and square
-Dress themselves
-Able to fasten large buttons without help
-Pull up a zipper after it is fastened

5-year-olds:
-Jump rope
-Walk backward
-Balance on one foot for at least 5 seconds
-Use scissors
-Begin learning how to tie shoes
-Draw a triangle and diamond
-Draw a person with six body parts
-Know address and phone number
-Recognize and recite the alphabet
-Write first name
-Start to help with chores around the house
-Start to lose their baby teeth

What can my 4- to 5-year-old child say?
Speech development in children is very exciting for parents as they watch their children become social beings that can interact with others. At this age, a child can usually understand that letters and numbers are symbols of real things and ideas, and that they can be used to tell stories and offer information. Most will know the names and gender of family members and other personal information. They often play with words and make up silly words and stories.

4 and 5-year-olds vocabulary is between 1,000 and 2,000 words. Speech at this age should be completely understandable, although there may be some developmental sound errors and stuttering, particularly among boys.

While every child develops speech at his or her own rate, the following are some of the common milestones children may reach in this age group:

4-year-olds:
-May put together four to five words into a sentence
-Will ask questions constantly
-May know one color or more
-Likes to tell stories
-May use some “bad” words (if he or she has heard them spoken repeatedly)

5-year-olds:
-May put together six to eight words into a sentence
-May know four or more colors
-Knows the days of the week and months
-Can name coins and money
-Can understand commands with multiple instructions
-Talks frequently

What does my 4- to 5-year-old child understand?
As a child’s vocabulary increases, so does his/her understanding and awareness of the world around them. Children at this age begin to understand concepts and can compare abstract ideas.

While children may progress at different rates, the following are some of the common milestones children may reach in this age group:

4-year-olds:
-Begins to understand time
-Begins to become less aware of only one’s self and more aware of people around him/her
-May obey parent’s rules, but does not understand right from wrong
-Believes that his or her own thoughts can make things happen

5-year-olds:
-Increased understanding of time
-Curious about real facts about the world
-May compare rules of parents with that of friends

Wellness and Fitness Milestones
By the time kids are 4 to 5 years old, their physical skills, like running, jumping, kicking, and throwing, have come a long way. Now they’ll continue to refine these skills and build on them to learn more complex ones. Take advantage of your child’s natural tendency to be active. Regular physical activity promotes healthy growth and development and learning new skills builds confidence.

How active should my child be at this age?
Kids at this age are learning to hop, skip and jump forward. They are eager to show off how they can balance on one foot, catch a ball or do a somersault. Preschoolers and kindergarteners also might enjoy swimming, playing on a playground, dancing and riding a tricycle or bicycle with training wheels.

Physical activity guidelines recommend that preschoolers and kindergarteners should:
-Be physically active throughout the day
-Move and engage in both active play and structured (adult-led) physical activities
-Do activities such as jumping, hopping and tumbling to strengthen bones and muscles

Should my 4- to 5-year-old child participate in sports?
Many parents look into organized sports to get 4 and 5-year-olds active. The average preschooler has not mastered the basics, such as throwing, catching and taking turns. Even simple rules may be hard for them to understand, as any parent who has watched their child run the wrong way during a game knows.

Starting too young can also be frustrating for kids and may discourage future participation in sports. If you decide to sign your child up for soccer or another team sport, be sure to choose a league that is right for their age and developmental stage. A peewee league that focuses on fun and learning the fundamentals might be great for a child still in preschool.

Family Fitness Tips
Playing together, running in the backyard or using playground equipment at a local park can be fun for the entire family. Other activities to try together, or for a group of preschoolers to enjoy, include:
-Playing games such as “Duck, Duck, Goose” or “Follow the Leader,” then mixing it up with jumping, hopping and walking backward
-Kicking a ball back and forth or into a goal
-Hitting a ball off a T-ball stand
-Playing freeze dance or freeze tag

Kids can be active even when they’re indoors. Designate a safe play area and try some active inside games such as:
-Treasure hunt: Hide “treasures” throughout the house and provide clues to their locations
-Obstacle course: Set up an obstacle course with chairs, boxes, and toys for the kids to go over, under, through and around
-Soft-ball games: Use soft foam balls to play indoor basketball, bowling, soccer or catch. You can even use balloons to play volleyball or catch

How long should my 4- to 5-year-old sleep?
4 to 5-year-olds should be sleeping around 10-12 hours at night. Those who get enough rest may no longer need a daytime nap and can benefit from some quiet time in the afternoon. This is the age where they might be in preschool or in kindergarten. As they give up naps, they may go to bed at night earlier than they did as toddlers.

Communication Milestones
Communicating with our kids is one of the most pleasurable and rewarding parts of parenting. Children learn by absorbing information through daily interactions and experiences not only with us, but with other adults, family members, other kids, and the world.

Between the ages of 4 and 5, many kids enter preschool or kindergarten programs, with language skills a key part of learning in the classroom.

How does my 4- to 5-year-old child interact with others?
A very important part of growing up is the ability to interact and socialize with others. This can be a frustrating transition for the parent as children go through different stages, some of which are not always easy to handle. While every child is unique and will develop different personalities, the following are some of the common behavioral traits that may be present in your child:

4-year-olds can:
-Be very independent and may want to do things on his or her own
-Be selfish and do not like to share
-Be moody; mood swings are common in this age group
-Be aggressive during mood swings towards family members
-Have a number of fears
-Have imaginary playmates
-Enjoy exploring the body and may play doctor and nurse
-“Run away” or threaten to do so
-Fight with siblings
-Play with others in groups

5-year-olds can:
-Generally, be more cooperative and responsible than 4-year-olds
-Be eager to please others and make them happy
-Have good manners
-Dress self completely without help
-Get along well with parents
-Enjoy cooking and playing sports
-Become more attached to parent as they enter school

Interacting with Your Child
Kids learn more through interactive conversation and play. Reading books, singing, playing word games and simply talking to kids will increase their vocabulary while providing increased opportunities to develop listening skills. As kids gain language skills, they also develop their conversational abilities. Kids 4 to 5 years old can follow more complex directions and enthusiastically talk about things they do. They can make up stories, listen attentively to stories and retell stories.

Here some ways you can help boost your child’s communication skills:

-Talk about the day’s activities
-Talk with your child about the books you read together
-Talk with your child about the TV programs and videos you watch together
-Keep books, magazines, and other reading material where kids can reach them without help
-Help kids create their own “This Is Me” or “This Is Our Family” album with photographs or mementos

How can I help increase my preschool child’s social ability?
Consider the following as ways to foster your preschool child’s social abilities:
-Offer compliments for good behavior and achievements
-Encourage your child to talk to you and be open with his or her feelings
-Read to your child, sing songs and talk with him or her
-Spend quality time with your child and show him or her new experiences
-Encourage your child to ask questions and explore
-Encourage physical activity with supervision
-Arrange times for your child to be with other children, such as in play groups
-Give your child the chance to make choices, when appropriate
-Use time-out for behavior that is not acceptable
-Encourage your child to express his or her anger in an appropriate manner
-Limit television watching (or other screen time) to 1 to 2 hours a day. Use free time for other more productive activities.

When should I call the doctor?
You should talk to your doctor if you suspect your child has a problem with hearing, language skills or speech clarity. A hearing test may be one of the first steps to find out if your child has a hearing problem.

Communication problems among kids in this age group include:
-Hearing problems
-Trouble following directions
-Trouble asking or answering questions
-Difficulty holding a conversation
-Poor vocabulary growth
-Trouble learning preschool concepts, such as colors and counting
-Stuttering
-Trouble putting sentences together
-Unclear speech

Some kids will outgrow these problems. Others might need speech therapy or further evaluation. This is especially important to assess at a young age because some children that have difficulty with communication may get frustrated, angry and even aggressive because they cannot relay their thoughts and feelings clearly.

Middle Childhood

Middle childhood brings many changes in a child’s life. By this time, children can dress themselves, catch a ball more easily using only their hands, and tie their shoes. Having independence from family becomes more important now. Events such as starting school bring children this age into regular contact with the larger world. Friendships become more and more important. Physical, social, and mental skills develop quickly at this time. This is a critical time for children to develop confidence in all areas of life, such as through friends, schoolwork, and sports.

Here is some information on how children develop during middle childhood:

Emotional/Social Changes
Children in this age group might:
-Show more independence from parents and family.
-Start to think about the future.
-Understand more about his or her place in the world.
-Pay more attention to friendships and teamwork.
-Want to be liked and accepted by friends.

Thinking and Learning
Children in this age group might:
-Show rapid development of mental skills.
-Learn better ways to describe experiences and talk about thoughts and feelings.
-Have less focus on one’s self and more concern for others.

Positive Parenting Tips
Following are some things you, as a parent, can do to help your child during this time:

-Show affection for your child. Recognize her accomplishments.
-Help your child develop a sense of responsibility—ask him to help with household tasks, such as setting the table.
-Talk with your child about school, friends, and things she looks forward to in the future.
-Talk with your child about respecting others. Encourage him to help people in need.
-Help your child set her own achievable goals—she’ll learn to take pride in herself and rely less on approval or reward from others.
-Help your child learn patience by letting others go first or by finishing a task before going out to play. Encourage him to think about possible consequences before acting.
-Make clear rules and stick to them, such as how long your child can watch TV or when she has to go to bed. Be clear about what behavior is okay and what is not okay.
-Do fun things together as a family, such as playing games, reading, and going to events in your community.
-Get involved with your child’s school. Meet the teachers and staff and get to understand their learning goals and how you and the school can work together to help your child do well.
-Continue reading to your child. As your child learns to read, take turns reading to each other.
-Use discipline to guide and protect your child, rather than punishment to make him feel bad about himself. Follow up any discussion about what not to do with a discussion of what to do instead.
-Praise your child for good behavior. It’s best to focus praise more on what your child does (“you worked hard to figure this out”) than on traits she can’t change (“you are smart”).
-Support your child in taking on new challenges. Encourage her to solve problems, such as a disagreement with another child, on her own.
-Encourage your child to join school and community groups, such as a team sports, or to take advantage of volunteer opportunities.

Your child’s growth and development at age 8
Age 8 can be a magical year. It’s the year that your little kid really becomes a big kid. Middle childhood is a time of physical, mental, and emotional growth. It’s possible you’ll notice that your child no longer asks for your help with their homework and they may be wanting to spend more time with their friends.

Eight-year-olds are becoming more independent and more mature. You may be pleased to see that they begin to show genuine empathy for others and start to put others first in situations that they haven’t before, such as happily letting a younger sibling go first in a family game. This age is not without its challenges, but overall, it tends to be a peaceful and enjoyable year between children and their parents.

Here, we’ll break down all you need to know about your 8-year-old’s development emotionally, socially, and physically, as well as brief your on safety tips and when certain concerns might warrant a call to your child’s pediatrician.

8-Year-Old Language and Cognitive Milestones
Eight years old is a time of great vocabulary growth for your child. Don’t be surprised if they are able to carry on more complex conversations with you, whether it’s a discussion on how tornadoes originate or vivid descriptions of what happened with their friends at recess that day. Eight-year-olds continue to rapidly develop their vocabularies, with an estimated 3,000 new words learned during the year. Reading to your child, encouraging them to read independently, and engaging them in conversation will help to support this.

You may also find your 8-year-old reading a chapter book with a flashlight long past their bedtime. “They may show an interest in reading as a favorite activity,” notes Pierrette Mimi Poinsett, MD, a pediatrician and a medical consultant at Mom Loves Best.

Younger children think purely concretely and have a harder time understanding abstract concepts. By age 8, kids begin to move into more abstract thinking. “Eight-year-old students are beginning to understand numbers in a more complex way,” notes Elizabeth Fraley, M.Ed., CEO of Kinder Ready Inc., an LA-based education program.

Before, your child may have needed to physically count out a group of objects in order to solve a math problem like 21 minus seven. Now, abstract thinking allows them to rely on symbols rather than being mostly dependent upon the use of counters or other manipulative materials. So, they can write out a simple equation and solve it using an algorithm while mostly grasping why this method works. Abstract thinking allows kids to be able to work with larger numbers, such as numbers in the thousands, and it allows them to conceptualize symbols, such as the multiplication or division signs.

Abstract thinking also means that kids can begin to have a better understanding of how money works and what lengths of time represent. Most kids this age are able to tell time and exhibit a better understanding of how long time increments are. When you say, “You have 10 more minutes until we have to leave,” or “Your birthday is three days away,” your child will have a greater understanding of what that means than they might have before.

8-Year-Old Movement, Hand, and Finger Milestones
For 8-year-old children, physical development is more about the refinement of skills, coordination, and muscle control rather than huge changes. So, you might not see them doing anything totally new, but you may notice that they are able to balance better and move more intentionally. Their locomotor and motor skills, such as turning, spinning, and jumping, become more fluid.

“Kids at this age may enjoy roller skating and using a skateboard or riding their bike,” notes Dr. Poinsett. “They may also like to dance to music.”
Fine motor skills will generally become more precise around age 8. Handwriting will become smaller, neater, and all of the letters will likely be the same size. The small muscles will have more stamina so your child may be able to write a full story without losing precision in their handwriting. “You don’t see as many letters and numbers flipped and reversed as you did in first and second grade,” notes Fraley.

An 8-year-old is likely able to open lunch items like wrappers or zip-lock bags independently and they may be able to play an instrument, such as the recorder. “They should also master being able to tie their shoelaces if they have not already,” says Dr. Poinsett.

8-Year-Old Emotional and Social Milestones
If your 8-year-old receives a present they don’t like, you may notice (with relief!) that they can still smile and thank the gift giver. This ability to mask their true thoughts or emotions to spare someone’s feelings is related to a newly developing ability to see things from another person’s point of view, called decentralization.

Decentralization allows children to show more sophisticated and complex emotions and interactions. Children begin to understand how someone else feels in a given situation and will be more capable of placing themselves in another person’s shoes.

Your child may take great pride in being a member of a sports team or other group. This is related to them developing a more sophisticated sense of themselves in the world. Their interests, talents, friends, and relationships with family members help them establish a clear self-identity and boost their self-confidence.

“Students at this age are skilled at interacting with adults and peers,” says Fraley. “They tend to use more eye contact and they have developed some stable and exciting friendships.” Eight-year-olds really value friendships and are able to make choices on who they want as a friend and value others’ distinct characteristics.

In general, 8-year-old children enjoy school and will count on and value relationships with a few close friends and classmates, and may gravitate primarily toward friendships with peers of the same sex. “They typically desire to be part of a team, club, or organization,” notes Fraley. “This age group really loves feeling united and needed within a group setting whether it be athletic or academic.”

A newly developing sense of self may cause your child to desire more privacy. You can support this need by knocking before you enter their bedroom and allowing them to change out of sight if this is what they desire.

Eight-year-olds are maturing steadily as they enter middle childhood. They will be able to take on more responsibilities, such as caring for a pet or washing a load of their own laundry. They may also show more interest in taking care of personal hygiene, and are developmentally capable of being responsible for personal care routines. “At this age, kids are generally able to take care of hygiene, such as brushing teeth and bathing,” notes Dr. Poinsett.

Becoming fully independent is a long and slow process that won’t be complete for many more years, however. Kids may begin to ask for sleep-overs, although parents should not be surprised if some children want to go back home and do not make it through the entire night at a friend’s house. Many children are still attached to their parents and home at this age, and might not be emotionally ready to handle being away from these comforts, even though they wish to be.

How to Help Your 8-Year-Old Learn and Grow
You can help your 8-year-old learn and grow by providing a good balance of independence and loving support. Give them a chance to try things on their own, while remaining close and available to help them if they need it.

Support your child’s blossoming literacy by exposing them to a variety of books. “Read to your child but also give them a chance to read to you,” says Dr. Poinsett. Make time to play with your child as well. Many 8-year-olds will enjoy doing puzzles together or playing family games like dominoes or charades.

Some 8-year-olds may become more aware of body image, and their confidence about their appearance may affect how they feel about themselves and their relationships with their peers. It’s important to talk about health, rather than appearance, and help your child find activities that help them feel good about themselves.

If your child tends to get frustrated easily, help them learn how to self-calm with strategies such as taking a deep breath or counting to 10. Praise your child for coping with emotions in a healthy way. You might say, “Great job taking a break for a minute when you were frustrated with your math homework.” Look for opportunities to keep teaching your child more sophisticated emotion regulation skills.

While it’s great to be supportive, kids also need a chance to use their budding problem-solving skills to tackle some challenges they encounter on their own. Whether they keep forgetting their soccer cleats for practice or don’t know how to complete their science fair project, encourage them to brainstorm potential solutions. Then, help them choose a strategy to try.

How to Keep Your 8-Year-Old Safe
Many 8-year-olds love to play sports, and it’s important to encourage daily physical activity. To stay safe, kids should wear protective gear when they play sports. Bike riding is a fun way for kids to get the exercise they need, but bike safety is very important. Teach your child the importance of always wearing a helmet while riding, and set a limit that bikes should only be written during daylight hours.

Just as important as bike safety is car safety. Kids today stay in car seats a lot longer than many parents will remember from their own childhoods. Most 8-year-olds still need a booster seat. The extra height from a booster seat ensures that the seat belt is positioned correctly on your child’s body so that it will do its job in the event of a crash.

If your 8-year-old is 4 feet 9 inches or taller, they can stop using a booster seat. However, they should remain in the back seat, and they should wear their seat belts every time the car is in motion.

At the age of 8, you still need to supervise your child any time they play around water. Even if they can swim, it is not safe for them to play in the water without an adult actively watching them. In addition, they should not play in fast-moving water like canals or the ocean when a riptide might come in.

When to Be Concerned
While kids develop at slightly different rates, it’s important to keep an eye on your child’s progress. If your child seems to be behind physically, emotionally, socially, or cognitively, talk to their pediatrician.

If your child has serious difficulty managing their emotions (including anger), or if their social skills aren’t on par with those of peers, there may be a reason for concern.10 Kids at this age who fall behind emotionally and socially may struggle to catch up without a little extra support. Consider talking to your child’s teacher or a child mental health professional to plan a course of action.

It’s best to err on the side of caution by expressing your concerns to a professional. From health issues to learning disabilities, early intervention can be key to a faster and easier resolution.

Watching your 8-year-old grow increasingly independent can be a joyful time for parents. And sometimes, it can bring about some sadness as you realize your baby is growing up.

Even though it can be hard, it’s important to promote independence as much as possible. Encourage your child to learn, grow, explore, and try new things. But remember, they are just getting their feet wet in their role as a “big kid.” As your child tackles new challenges, remain available to provide support when they need it.

Child Safety First
More physical ability and more independence can put children at risk for injuries from falls and other accidents. Motor vehicle crashes are the most common cause of death from unintentional injury among children this age.

-Protect your child properly in the car.
-Teach your child to watch out for traffic and how to be safe when walking to school, riding a bike, and playing outside.
-Make sure your child understands water safety, and always supervise her when she’s swimming or playing near water.
-Supervise your child when he’s engaged in risky activities, such as climbing.
Talk with your child about how to ask for help when she needs it.
-Keep potentially harmful household products, tools, equipment, and firearms out of your child’s reach.

Healthy Bodies
-Parents can help make schools healthier. Work with your child’s school to limit access to foods and drinks with added sugar, solid fat, and salt that can be purchased outside the school lunch program.
-Make sure your child has 1 hour or more of physical activity each day.
-Keep television sets out of your child’s bedroom. Set limits for screen time for your child at home, school, or after school care and develop a media use plan for your family.
-Practice healthy eating habits and physical activity early. Encourage active play, and be a role model by eating healthy at family mealtimes and having an active lifestyle.
-Make sure your child gets the recommended amount of sleep each night: For school-age children 6-12 years, 9–12 hours per 24 hours (including naps)

References
choc.org, “Developmental Milestones: 4 to 5 Year Olds (Preschool).”; cdc.gov, “Middle Childhood (6-8 years of age).”; verywell.com, “8-Year-Old Child Developmental Milestones.” By Elisa Cinelli;

Chapter 5–Puberty
The period from ages nine to thirteen, which is the beginning of adolescence. It is the time in life when a boy or girl becomes sexually mature. It causes physical changes, and affects boys and girls differently.

When your body reaches a certain age, your brain releases a special hormone that starts the changes of puberty. It’s called gonadotropin-releasing hormone, or GnRH for short. When GnRH reaches the pituitary gland (a pea-shaped gland that sits just under the brain), this gland releases into the bloodstream two more puberty hormones: luteinizing hormone (LH for short) and follicle-stimulating hormone (FSH for short). Guys and girls have both of these hormones in their bodies. And depending on whether you’re a guy or a girl, these hormones go to work on different parts of the body.

For guys, these hormones travel through the blood and give the testes the signal to begin the production of testosterone and sperm. Testosterone is the hormone that causes most of the changes in a guy’s body during puberty. Sperm cells must be produced for men to reproduce.

In girls, FSH and LH target the ovaries, which contain eggs that have been there since birth. The hormones stimulate the ovaries to begin producing another hormone called estrogen. Estrogen, along with FSH and LH, causes a girl’s body to mature and prepares her for pregnancy.

So that’s what’s really happening during puberty — it’s all these new chemicals moving around inside your body, turning you from a teen into an adult with adult levels of hormones.

Puberty usually starts some time between age 7 and 13 in girls and 9 and 15 in guys. Some people start puberty a bit earlier or later, though. Each person is a little different, so everyone starts and goes through puberty on his or her body’s own schedule. This is one of the reasons why some of your friends might still look like kids, whereas others look more like adults.

In girls:

The first sign of puberty is usually breast development.
Then hair grows in the pubic area and armpits.
Menstruation (or a period) usually happens last.

In boys:

Puberty usually begins with the testicles and penis getting bigger.
Then hair grows in the pubic area and armpits.
Muscles grow, the voice deepens, and facial hair develops as puberty continues.
Both boys and girls may get acne. They also usually have a growth spurt (a rapid increase in height) that lasts for about 2 or 3 years. This brings them closer to their adult height, which they reach after puberty.

Puberty is a time of big changes for a teen that eventually ends with the full maturation of the body.

The different stages can be challenging and even confusing for teens, especially since the time line of these changes is different for each person. Puberty may also be difficult for any teens questioning their gender identity.

Explaining the process to your child can help them know what to expect. And if you or your child have any concerns about how the process is unfolding, it may even be helpful to contact your pediatrician for additional guidance.

What are the Tanner stages of puberty?
Professor James M. Tanner, a child development expert, was the first to identify the visible stages of puberty.

Today, these stages are known as the Tanner stages or, more appropriately, sexual maturity ratings (SMRs). They serve as a general guide to physical development, although each person has a different puberty timetable.

Here’s what you can expect to see based on the Tanner stages in males and females during puberty.

Tanner stage 1
Tanner stage 1 describes what’s happening to your child before any physical signs of puberty appear. It typically starts after a female’s 8th birthday and after a male’s 9th or 10th birthday. At this stage, these internal changes are the same for males and females.

The brain begins to send signals to the body to prepare for changes.
The hypothalamus begins to release gonadotropin-releasing hormone (GnRH) to the pituitary gland, which makes hormones that control other glands in the body.
Pituitary gland starts to make two other hormones: luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
Physical changes aren’t noticeable for males or females at this stage.

Tanner stage 2
Stage 2 marks the beginning of physical development. Hormones begin to send signals throughout the body.

Females
Puberty usually starts between ages 9 and 11. Visible changes include:

First signs of breasts, called “buds,” start to form under the nipple. They may be itchy or tender or one bud may be larger than the other, which is normal.
Darker area around the nipple (areola) will also expand.
Uterus begins to get larger, and small amounts of pubic hair start growing on the lips of the vulva.
On average, Black females start puberty trusted Source a year before white females and are ahead when it comes to breast development and having their first periods. Also, females with higher body mass indexTrusted Source experience an earlier onset of puberty.

Males
In males, puberty usually starts around age 11. The testicles and skin around the testicles (scrotum) begin to get bigger.

Puberty usually starts around age 11. Changes include:

Testicles and skin around the testicles (scrotum) begin to get bigger.
Early stages of pubic hair form on the base of the penis.

Tanner stage 3
Physical changes are becoming more obvious for both males and females in stage 3. Along with a growth spurt in height, your teen’s hormones are hard at work, furthering development from the previous stage.

Females
Physical changes in females usually start after age 12. These changes include:

Breast “buds” continue to grow and expand.
Pubic hair gets thicker and curlier.
Hair starts forming under the armpits.
The first signs of acne may appear on the face and back.
The highest growth rate for height begins (around 3.2 inches per year).
Hips and thighs start to build up fat.

Males
Physical changes in males usually start around age 13. These changes include:

Penis gets longer as testicles continue to grow bigger.
Some breast tissue may start to form under the nipples (this happens to some teenage males during development and usually goes away within a couple of years).
Males begin to have wet dreams (ejaculation at night).
As the voice begins to change, it may “crack,” going from high to lower pitches.
Muscles get larger.
Height growth increases to 2 to 3.2 inches per year.

Tanner stage 4
Puberty is in full swing during stage 4. Both males and females are noticing many changes.

Females
In females, stage 4 usually starts around age 13. Changes include:

Breasts take on a fuller shape, passing the bud stage.
Many females get their first period, typically between ages of 12 and 14, but it can happen earlier.
Height growth will slow down to about 2 to 3 inches per year.
Pubic hair gets thicker.

Males
In males, stage 4 usually starts around age 14. Changes include:

Testicles, penis, and scrotum continue to get bigger, and the scrotum will get darker in color.
Armpit hair starts to grow.
Deeper voice becomes permanent.
Acne may start to appear.

Tanner stage 5
Stage 5 begins the culmination of your teen’s development. In this final phase, your teen will eventually reach full physical maturation, including their final adult height.

Females
In females, stage 5 usually happens around age 15. Changes include:

Breasts reach approximate adult size and shape, though breasts can continue to change through age 18.
Periods become regular after 6 months to 2 years.
Females reach adult height 1 to 2 years after their first period.
Pubic hair fills out to reach the inner thighs.
Reproductive organs and genitals are fully developed.
Hips, thighs, and buttocks fill out in shape.

Males
In males, stage 5 usually starts around age 15. Changes include:

Penis, testicles, and scrotum will have reached adult size.
Pubic hair has filled in and spread to the inner thighs.
Facial hair will start coming in and some males will need to begin shaving.
Growth in height will slow down, but muscles may still be growing.
By age 18, most males have reached full growth.

Tanner stages summary
Tanner stages in females Age at the start Noticeable changes
Stage 1 After the 8th birthday None
Stage 2 From age 9–11 Breast “buds” start to form; pubic hair starts to form
Stage 3 After age 12 Acne first appears; armpit hair forms; height increases at its fastest rate
Stage 4 Around age 13 First period arrives
Stage 5 Around age 15 Reproductive organs and genitals are fully developed

Tanner stages in males Age at the start Noticeable changes
Stage 1 After the 9th or 10th birthday None
Stage 2 Around age 11 Pubic hair starts to form
Stage 3 Around age 13 Voice begins to change or “crack”; muscles get larger
Stage 4 Around age 14 Acne may appear; armpit hair forms
Stage 5 Around age 15 Facial hair comes in

Other signs and symptoms of puberty

Acne in puberty
Changing hormones cause oils to build up on the skin and clog pores, resulting in acne. Your child can develop acne on the face, back, or chest. Some people have worse acne than others.

If you have a family history of acne or if your child has severe acne, your pediatrician may recommend prescription treatments. Otherwise, encourage your child to treat acne by washing daily with mild soap and using over-the-counter (OTC) creams and ointments as needed to control breakouts.

A trip to the dermatologist may be warranted for more persistent acne.

Body odor in puberty
Larger sweat glands also develop during puberty. To prevent body odor, talk with your child about deodorant options and make sure they shower regularly, especially after intense physical activity.

Learn more about hygiene habits for kids and teens.

Mood changes in puberty
Is your teen is moody or otherwise behaving differently? Hormones or your child’s feelings about physical changes, friends, or school may be the culprit. If you’re concerned, there are a number of mental health resources you can find online as well as local support groups, school psychologists, and community programs that may help.

Be on the lookout for signs of depression or anxiety, like trouble sleeping, avoidance, or poor performance in school. Any extreme or troubling mood changes should be discussed with your child’s doctor. In some cases, therapy or medication may help.

Takeaway
Puberty doesn’t happen overnight. It’s a years-long process involving various physical and hormonal changes — all of which can be uncomfortable to go through.

Your child is likely having a lot of feelings right now, whether it’s about acne, body odor, menstrual cramps, or something else. Keep the line of communication open and be patient while discussing these feelings. Reassure your child that what’s going on is normal and an expected part of puberty.

If something does seem particularly troubling or if you have concerns about your child’s development, don’t hesitate to speak with your child’s doctor.

References
medlineplus.gov, “puberty.”; kidshealth.org, “Everything You Wanted to Know About Puberty.”; healthline.com, “Navigating Puberty: The Tanner Stages.” By Carissa Stephens and Ashley Marcin;

Chapter 6–Adolescent/Teenager
The stage that takes place between ages fourteen and eighteen.

Adolescence is the exciting yet stressful time when your child transitions into adulthood. Many rapid changes and developments take place during this time, and it’s not always a smooth ride. Through the physical, cognitive and psychological changes, your child will begin to discover who they are and where they belong.

What happens during adolescence stage?
They are sensitive, and worried about their own body changes. They may make painful comparisons about themselves with their peers. Physical changes may not occur in a smooth, regular schedule. Therefore, adolescents may go through awkward stages, both in their appearance and physical coordination.

What are the 5 different developmental stages of adolescence?

Stages of Adolescence
Early Adolescence. Early adolescence occurs between ages 10-13, though it can begin a year or two earlier, especially for girls. …
Middle Adolescence. Middle adolescence occurs between ages 14-17. …
Late Adolescence. Late adolescence occurs between ages 18-21. …
Physical Development. …
Cognitive Development.

What are the characteristics of adolescent behavior?
Behaviorally, adolescence is associated with volatile emotions and boundary-testing behavior as individuals explore and assert personal identity, learn to navigate peer relationships, and transition to independence.

What are the 8 behavioral traits of teenager?

-Lying. Many teens lie out of fear of the consequences for their behavior, or even fear that you will be upset or withdraw love if they tell you the truth. …
-Arguing. …
-Defiance. …
-An awkward phase. …
-Abandoning commitments. …
-Withdrawal. …
-Attitude. …
-Impulsivity.

What is adolescence?
Adolescence is the period of transition between childhood and adulthood. Children entering adolescence are going through many changes in their bodies and brains. These include physical, intellectual, psychological and social challenges, as well as development of their own moral compass. The changes are rapid and often take place at different rates. It can be an exciting yet challenging time in the life of a teenager. Adolescence is the time when your child becomes more independent and begins to explore their identity.

What are the physical changes of adolescence?
Physical development in adolescence includes changes that occur through a process called puberty. During puberty, your child’s brain releases certain hormones. The hormones cause your child’s body to physically change and their sexual organs to mature.

Your child will likely experience a growth spurt. During this time, they’ll grow rapidly in height and weight. Other physical changes may include body odor, acne and an increase in body hair. Growth spurts usually happen earlier for girls and adolescents assigned female at birth (AFAB) than for boys and adolescents assigned male at birth (AMAB). Most girls and adolescents AFAB have growth spurts between the ages of 10 and 14. Most boys and adolescents AMAB have growth spurts between the ages of 14 and 17.

Girls and adolescents AFAB will begin to develop breasts. This can happen as young as age 10 and should start by age 14. They’ll also experience their first period (menstruation) — usually about two years after breasts and pubic hair are first noticeable.

Boys and adolescents AMAB will see their penis and testicles grow. They’ll begin to experience erections and ejaculations. (Erections can also happen normally from before birth — as seen on ultrasound in utero — to old age.)

These physical changes happen to everyone, but the timing and order can vary from person to person. Some adolescents mature early, while others mature later. Being on either end of this spectrum can cause the added stress of standing out amongst their peers.

If puberty is happening early (before age 8 for girls and adolescents AFAB and before age 9 for boys and adolescents AMAB) or late (after age 14 for girls and adolescents AFAB and after age 15 for boys and adolescents AMAB), see your pediatrician or an adolescent medicine doctor. They can help manage and treat this problem of puberty. Ignoring these problems can have an impact on bone development and growth.

What are the cognitive changes of adolescence?
Brain development in adolescence is on a higher level than that of childhood. Children are only able to think logically about the concrete — the here and now. Adolescents move beyond these limits and can think in terms of what might be true, rather than just what they see as true. They can deal with abstractions, test hypotheses and see infinite possibilities. Yet adolescents still often display egocentric behaviors and attitudes.

During cognitive development in adolescence, large numbers of neurons grow rapidly. Your child’s body experiences an increase in the way these bundles of nerves connect. This allows for more complex, sophisticated thinking.

Which part of the brain develops last in adolescence?
The front part of your child’s brain — the frontal cortex — is one of the last parts of their brain to fully develop. It won’t finish maturing until your child reaches their mid- to late 20s. This area of the brain controls executive functions such as planning, prioritizing and controlling impulses. Because it develops so late, your teenager may have lapses in judgment. You may see an increase in risk-taking behaviors and mood swings.

When a teen isn’t using their frontal cortex and is acting impulsively, this thought process is called hot cognition. Cold cognition means using the logical part of your brain, not being “cold.” Parents can help redirect a young person from “hot” to “cold” cognition by responding with empathy, asking questions rather than lecturing and holding them to high expectations.

Which mental characteristic develops over the course of adolescence?
Mental characteristics that develop during adolescence include improved:

-Abstract thinking.
-Reasoning skills.
-Impulse control.
-Creativity.
-Problem-solving abilities.
-Decision-making skills.

What are the emotional changes of adolescence?
During adolescence, your child will begin to observe, measure and manage their emotions. That means they’ll begin to become more aware of their own feelings and the feelings of others. The process of emotional development will give your child the opportunity to build their skills and discover their unique qualities. As they become more independent, some adolescents welcome these new challenges. Others may need more support to build their self-confidence.

How does self-esteem develop in adolescence?
The physical, hormonal and emotional changes your child experiences during adolescence may affect their self-esteem. Teenagers who develop early or late compared to their peers may be self-conscious of their bodies. Fitting in becomes ever more important to their self-esteem. Self-esteem can be complex. Some adolescents may have high self-esteem around their families but low self-esteem around their peers.

Instead of having a “helicopter parent” who swoops in and saves the day, or a “snowplow parent” who moves all challenges out of their child’s way, adolescents benefit most from a parent who’s a “lighthouse.” This kind of parent keeps their child in bounds whenever it’s a matter of safety or ethics, while allowing them to explore their own decision-making abilities. The role of caring adults who serve as a lighthouse can be life-changing for teens.

While a challenging part of adolescence, it’s important that your child learns to accept who they are and gains a sense of capability. They can develop their self-esteem by:

-Making mistakes.
-Learning from their mistakes.
-Holding themselves accountable for their actions.

What are the social changes of adolescence?
Adolescents are also developing socially during this time. The most important task of social development in adolescence is the search for identity. This is often a lifelong voyage that launches during adolescence. Along with the search for identity comes the struggle for independence. Your child may:

-Develop an interest in their sexuality and romantic relationships.
-Turn to you less in the midst of a challenge.
-Show more independence from you.
-Spend less time with you and more time with their friends.
-Feel anxious, sad or depressed, which can lead to trouble at school or risk-taking behaviors.

What is identity development in adolescence?
Identity development occurs when your child discovers a strong sense of self and personality, along with a connection to others. Positive self-identity is important because it shapes your child’s perception of belonging throughout their life.

A positive self-identity is also associated with higher self-esteem. You can help reinforce a positive self-identity in your child by:

-Encouraging their efforts.
-Praising their good choices.
-Inspiring perseverance.

How does social media affect adolescent development?
Social media can negatively impact your child’s health and development. Adolescents report cyberbullying and exposure to inappropriate content online. In addition, socializing online isn’t the same as socializing in person. Adolescents miss out on key facial expressions and body language that they only see when they connect with a person face to face. Adolescents may also feel bad about themselves when comparing themselves to others they see online. All of these factors can lead to lower self-esteem, depression and anxiety.

What are the moral changes of adolescence?
During adolescence, your child may start to think about the world in a deeper, more abstract way. This helps shape how your child sees the world and how they want to interact with it. Your child will also begin to develop morals and values that they’ll hold throughout their life.

Your child may begin to see that not every decision is black or white. They’ll develop empathy when they begin to see why people make choices that differ from their own. They’ll also begin to have a deeper understanding of why there are rules in the world. They’ll start to form their own opinions on what’s right and what’s wrong. They may also spend time thinking about their religious beliefs and spirituality. Encourage these conversations with your child whenever you have the opportunity. Practice the art of listening and learning as your child practices thinking through issues and situations.

Can ADHD develop in adolescence?
Healthcare providers typically diagnose attention-deficit/hyperactivity disorder (ADHD) in childhood. But some people don’t receive a diagnosis until adolescence or even adulthood. Teenagers with undiagnosed ADHD may struggle even more with the symptoms of ADHD as they enter adolescence. Other adolescents have unrecognized learning disorders, or ways of processing that differ from the norm. Falling grades are a red flag for unmasked ADHD, learning disorders or signs of stress, including depression.

How can parents support healthy adolescent development?
Adolescence can be a trying period for both you and your child. But your home doesn’t have to become a battleground if you make special efforts to understand one another. The following guidelines may help parents:

-Give your child your undivided attention when they want to talk. Don’t read, check your email, watch television or busy yourself with other tasks.
-Listen calmly and concentrate on hearing and understanding your child’s point of view.
-Reflect back what you have heard.
-Speak to your child as courteously and pleasantly as you would to a stranger. -Your tone of voice can establish the mood of a conversation.
-Understand your child’s feelings, even if you don’t always approve of their behavior.
-Try not to make judgments.
-Keep the door open on any subject. Be an “open/approachable” parent.
-Avoid humiliating your child.
-Don’t laugh at what may seem to you to be naive or foolish questions and statements.
-Encourage your child to “test” new ideas in conversation.
-Don’t judge their ideas and opinions. Instead, listen and then offer your own views as plainly and honestly as possible.
-Love and mutual respect can coexist with differing points of view.
-Help your child build self-confidence.
-Encourage their participation in activities of their choice (not yours).
-Make an effort to commend your child frequently and appropriately. Too often, we take the good things for granted and focus on the bad. Your child needs to know you appreciate them.
-Catch them doing something right and encourage them to do more of that.
-Encourage your child to participate in family decision-making and to work out family concerns together with you.
-Understand your child needs to challenge your opinions and your ways of doing things. This is how they achieve the separation from you that’s essential for their own adult identity.

What can adolescents do during this time?
Avoid looking at your parents as the enemy. Chances are they love you and have your best interests in mind, even if you disagree with their way of showing that.
-Try to understand that your parents are human beings with their own insecurities, needs and feelings.
-Listen to your parents with an open mind. Try to see situations from their point of view.
-Share your feelings with your parents so they can understand you better.
-Live up to your responsibilities at home and in school. That way, your parents will be more inclined to grant you the kind of independence you want and need.
-Bolster your criticisms of family, school and government with suggestions for practical improvements.
-Be as courteous and considerate to your parents as you would be to your friends’ parents.

In the next portion of this chapter I want to spend a little more time discussing the emotional component of Adolescence. I will finish this chapter with a discussion the neurology of the teenage brain. I hope this portion will help the reader to comprehend why the teenager goes through what they do and why this stage is so difficult. There may be a little redundancy but since this is such a pivotal and important stage in development I am sure the reader will understand.

Adolescence can be a time of both disorientation and discovery. The transitional period can raise questions of independence and identity; as adolescents cultivate their sense of self, they may face difficult choices about academics, friendship, sexuality, gender identity, drugs, and alcohol.

Most teens have a relatively egocentric perspective on life; a state of mind that usually abates with age. They often focus on themselves and believe that everyone else—from a best friend to a distant crush—is focused on them too. They may grapple with insecurities and feelings of being judged. Relationships with family members often take a backseat to peer groups, romantic interests, and appearance, which teens perceive as increasingly important during this time.

The transition can naturally lead to anxiety about physical development, evolving relationships with others, and one’s place in the larger world. Mild anxiety and other challenges are typical, but serious mental health conditions also emerge during adolescence. Addressing a disorder early on can help ensure the best possible outcome.

What is the purpose of adolescence?
The purpose of adolescence is for a child to psychologically and socially transform into a young adult. Breaking from their childhood attachment and security allows children to acquire freedom and responsibility to develop independence and to differentiate themselves from their parents and childhood to establish their own unique identity.

Why is puberty so challenging?
Puberty begins between ages 9 and 15, and it lasts between a year and a half to three years. The hormonal and biological changes that occur can lead adolescents to feel anxious and self-conscious and to require more privacy and become preoccupied with their appearance, which can influence how they are perceived and accepted.

Why do teens make bad decisions and take risks?
Adolescent risk-taking is often blamed on hormonal changes, but relationships play a key role as well. The teenage years are devoted to creating friendships that can serve individuals for life. Along those lines, research suggests that adolescents are motivated by peer acceptance more than adult perceptions—for better or for worse.

How does sleep change during adolescence?
The biological clock shifts during puberty, prompting teens to become sleepy later and therefore wake up later to get the recommended 8 to 10 hours of sleep. This is why later middle and high school start times are associated with improved attendance and grades as well as a lower likelihood of experiencing depression.

How Do I Talk to My Teen?
Speaking openly with adolescents about changes that they are experiencing can be a challenge for any parent, especially given the shift in the parent-child relationship during this time.

One important component of communicating with teens is helping them understand what lies ahead. Explaining how their bodies will change so that they aren’t caught by surprise can alleviate a child’s anxiety. Beyond physical changes, parents can begin a conversation about the social and lifestyle changes that accompany adolescence. Discussing the consequences of important decisions—like having sex or experimenting with drugs—can encourage a teen to reflect on their choices.

Listening is a powerful yet under-appreciated tool. Parents often orient toward directives and solutions. But setting aside those tendencies and simply listening to the teen can strengthen the relationship. Asking specific or prying questions can make the child feel judged and therefore hesitant to speak openly and honestly. Listening attentively shows interest, validation, and support. It also increases the chances that a teen will confide in a parent as needed. Active listening builds

intimacy and trust—while simultaneously allowing the teen to process their experience.

How can I maintain a close relationship with a teen?
Developing an independent identity during adolescence requires experimenting with new relationships and activities while gaining space from parents. But you can still maintain a close relationship despite that process. Express interest and ask questions about your teen’s new passions. Welcome their friends and provide family structure. In disciplinary situations, critique choices rather than character.

How do I talk to a teen about healthy sex?
Convey that you are open to discuss anything, such as sexual health, porn, pleasure, and love. During these conversations, listen openly and non-judgmentally. Shutting down a vulnerable adolescent with negativity or judgment can lead to shame and fear. Being open encourages them to trust you with future questions and to develop a healthy relationship with sex.

How do I talk to a teen about drugs and alcohol?
Most teens will experiment with some combination of alcohol, drugs, and smoking. But parents can inform the choices they make with guidance, such as that the decision to use should be intentional, not automatic and a personal choice, not a socially-pressured one. Parents should discuss the topic openly, honestly, and continually.

How can I support a teen when they’re upset?
Encourage them to share their feelings to ease the emotional burden, even if it’s not with you. Exploring the root of their unhappiness can also lead them to take action: If they’re bored, maybe they can find a new hobby or sport. Adolescence can be an emotional time, but these ideas and others can help.

How Does Mental Health Change During Adolescence?
Many of the mental health conditions people confront as adults begin to manifest in adolescence. In fact, one in five young adults has a diagnosable disorder, according to the Department of Health and Human Services.

However, teens can also struggle with anxiety, depression, and other forms of distress that are developmentally appropriate and will not necessarily endure. It’s difficult to know when a problem merits clinical attention, but when in doubt, querying a school counselor or another mental professional is the best course of action.

Parents can help by learning how to identify early warning signs of the disorder they feel concerned about and by not being afraid to ask about their child’s thoughts and experiences. Confronting mental health conditions and accessing treatment early on can prevent a disorder from increasing in severity or duration. When addressed early, most conditions can be managed or treated effectively.

Why are teenagers today so stressed and anxious?
An American Psychological Association report revealed that 91 percent of Generation Z has felt physical or emotional symptoms of stress, such as depression or anxiety. This stress may be due to parental trends like over scheduling, effects of social media like negative social comparisons, and historical events like the great recession and mass shootings.

How can I help an anxious teenager?
Parents can care for their teens by offering empathy and nonjudgmental support—focus on understanding them rather than judging them. Teens achieve more when not pressured to be perfect, so parents can avoid expressing the need for perfection. Maintaining a relationship and encouraging their relationships with other caring adults like teachers and mentors is also helpful.

How common are mental health disorders in college?
At least one in three first-year college students meets the criteria for a mental health disorder, research suggests. An array of factors can contribute to the onset of mental illness during this time: the transition to college, childhood trauma, biological changes, financial stress, academic pressure, lack of sleep, social isolation, and uncertainty about the future.

How can I help a college student access mental health care?
Encourage your child to seek out university mental health services. If the university is unable to provide treatment due to high demand, your child can explore meeting with other health professionals on campus like a doctor or nurse practitioner, asking a campus case manager to help find care off-campus, and beginning teletherapy.

What’s the relationship between social media use and mental health?
Pinning down the relationship between social media and mental health is notoriously difficult. Some recent research suggests that social media doesn’t fuel depression; rather, depression may lead to more social media use, at least among adolescent girls.

The brain of the adolescent goes through a phase of plasticity and pruning of synapses (brain pathways) as did the brain of the toddler years earlier. Environmental factors can have major, lasting effects on this changing brain circuitry. Because adolescents are so readily influenced by emotions, they stand to profit from learning in a positive emotional context that is intentionally designed to train emotional regulation. Thankfully, emotional regulation and the brain structures responsible for it are influenced by parent-child interactions. The same plasticity that creates the unique adolescent experience gives parents and teachers the ability to wield strong influence on the adolescent brain. Repetitive exposure to emotionally regulated people and regulating experiences (rhythmic and repetitive sensory experiences like breathing, dancing and walking) and extensive practice in handling difficult social interactions prepare the teen brain to withstand peer pressure when it inevitably arrives. This assumes, of course, that the parent or teacher arrives with their own regulation intact and strong enough to resist emotional contamination by the erratic teen. Don’t lose your cool when they lose theirs.

It’s a “use or lose it” developmental phase and both risks and benefits are high. The good news for kids from childhood trauma: “Many synapses are formed in childhood that are later removed in adolescence. This occurs in an experience-dependent way, i.e., the synapses that survive are the ones that are more often ‘in use.’” The teen’s long term functioning is more influenced by the wide network of adults who take an interest in them than those earlier, stressful events.

During this period of brain development, when the rewards of social connection (in the limbic system) out-pace the ability to think about consequences (in the prefrontal cortex), adolescents seek novelty and strong emotions, sometimes putting their health and future plans at serious risk. The reorganization of brain circuitry responsible for planning and cause and effect is temporarily made a slave of the part of the brain responsible for emotions and social connections. Evidence of this is seen in the impulsive decision making and emotional dysregulation typical of teens. In situations that are particularly emotionally laden (e.g., in the presence of other adolescents or when there is the prospect of an immediate reward), the probability rises that rewards and social approval (coolness) will affect behavior more strongly than rational decision-making processes. The social approval of peers—is more desired than any risk is to be avoided or even considered.

Interestingly, all this risk taking does make a bit of sense in light of their impending entry into adulthood and the extrication from their primary family necessary for that to happen. Now throw puberty into the mix and the gush of estrogens may make girls more susceptible to stress, while the androgen rush makes boys more resilient to it. It occurs to me that the image of the beauty tied to the railroad tracks while her rescuer rides in on his white horse seems to sum up the previous sentence perfectly. Though somewhat sexist, this image is apparently consistent with this period of neurological re-development that may last through the twenties.

Having any history of persistent trauma in childhood further complicates this picture but not a lot. I invite you to take our course in the Neurosequential Model of Caregiving to get a deeper understanding of that but in essence: Stay regulated so you can help your child become more regulated so trust between you can grow enough to open the door to important conversations about becoming a person of good character. Just like a traumatized child, a teen’s brain is more vulnerable to their emotional state and less influenced by rational thinking about longer term consequences. Both can benefit from practicing tricky social situations in the context of a positive, supportive relationship.

References
my.clevelandclinic.org, “Adolescent Development.”; psychologytoday.com, “Adolescence.”; azafap.org, “Neurological Adolescence.” By Cathy Tompkins;

Chapter 7–Early Adulthood
The period spans from age nineteen (end of adolescence) until 40 to 45 years of age. More recently, developmentalists have divided this age period into two separate stages: Emerging adulthood followed by early adulthood.

When we are children and teens, we eagerly anticipate each and every birthday, waiting for the next big one…when we’ll finally be grown up and have all the freedoms and rights enjoyed by those who are older than us. Indeed, there are opportunities to drive, buy a car, vote, go to college, join the military, drink, move out on our own, date, live together, get married, work, have children, buy a house, and more. This can be an awesome time in our lives, as we tend to be physically and cognitively strong and healthy, we dream and make plans for the future, find people to share our experiences, and try out new roles. It can also be challenging, stressful, and scary as we realize that a lot of responsibility comes with such freedom. We have probably all seen the coffee mugs that proclaim, “Adulting is hard,” or the t-shirts that announce, “I can’t adult today” (typically worn by young adults!).

Development is a process, and we aren’t suddenly adults at a certain age. In fact, we may even take longer to grow up these days. In this module, we’ll learn about norms, trends, and theories about why certain patterns are forming. It’s even been proposed that there is a new stage of development between adolescence and early adulthood, called “emerging adulthood,” when young people don’t quite feel like they are adults yet and wait longer to join the workforce, move out on their own, get married, and have children. Yet by the end of early adulthood, most of us will have accomplished the important developmental tasks of becoming more autonomous, taking care of ourselves and even others, committing to relationships and jobs/careers, getting married, raising families, and becoming part of our communities. There are, of course, many individual and cultural differences.

Think of your own life. When will you feel like an adult? Or do you already feel like an adult? Why or why not? Did your parents become adults earlier or later in their lives, compared to you?

Before we dive into the specific physical changes and experiences of early adulthood, let’s consider the key developmental tasks during this time—the ages between 18 and 40. The beginning of early adulthood, ages 18-25, is sometimes considered its own phase, emerging adulthood, but the developmental tasks that are the focus during emerging adulthood persist throughout the early adulthood years. Look at the list below and try to think of someone you know between 18 and 40 who fits each of the descriptions.

Developmental Tasks of Early Adulthood
Havighurst describes some of the developmental tasks of young adults. These include:

1. Achieving autonomy: trying to establish oneself as an independent person with a life of one’s own
2. Establishing identity: more firmly establishing likes, dislikes, preferences, and philosophies
3. Developing emotional stability: becoming more stable emotionally which is considered a sign of maturing
4. Establishing a career: deciding on and pursuing a career or at least an initial career direction and pursuing an education
5. Finding intimacy: forming first close, long-term relationships
6. Becoming part of a group or community: young adults may, for the first time, become involved with various groups in the community. They may begin voting or volunteering to be part of civic organizations (scouts, church groups, etc.). This is especially true for those who participate in organizations as parents.
7. Establishing a residence and learning how to manage a household: learning how to budget and keep a home maintained.
8. Becoming a parent and rearing children: learning how to manage a household with children.
9. Making marital or relationship adjustments and learning to parent.

Physical Development in Early Adulthood
The Physiological Peak
People in their twenties and thirties are considered young adults. If you are in your early twenties, you are probably at the peak of your physiological development. Your body has completed its growth, though your brain is still developing (as explained in the previous module on adolescence). Physically, you are in the “prime of your life” as your reproductive system, motor ability, strength, and lung capacity are operating at their best. However, these systems will start a slow, gradual decline so that by the time you reach your mid to late 30s, you will begin to notice signs of aging. This includes a decline in your immune system, your response time, and your ability to recover quickly from physical exertion. For example, you may have noticed that it takes you quite some time to stop panting after running to class or taking the stairs. But, remember that both nature and nurture continue to influence development. Getting out of shape is not an inevitable part of aging; it is probably due to the fact that you have become less physically active and have experienced greater stress. The good news is that there are things you can do to combat many of these changes. So keep in mind, as we continue to discuss the lifespan, that some of the changes we associate with aging can be prevented or turned around if we adopt healthier lifestyles.

In fact, research shows that the habits we establish in our twenties are related to certain health conditions in middle age, particularly the risk of heart disease. What are healthy habits that young adults can establish now that will prove beneficial in later life? Healthy habits include maintaining a lean body mass index, moderate alcohol intake, a smoke-free lifestyle, a healthy diet, and regular physical activity. When experts were asked to name one thing they would recommend young adults do to facilitate good health, their specific responses included: weighing self often, learning to cook, reducing sugar intake, developing an active lifestyle, eating vegetables, practicing portion control, establishing an exercise routine (especially a “post-party” routine, if relevant), and finding a job you love.

Being overweight or obese is a real concern in early adulthood. Medical research shows that American men and women with moderate weight gain from early to middle adulthood have significantly increased risks of major chronic disease and mortality. Given the fact that American men and women tend to gain about one to two pounds per year from early to middle adulthood, developing healthy nutrition and exercise habits across adulthood is important.

A Healthy, but Risky Time
Early adulthood tends to be a time of relatively good health. For instance, in the United States, adults ages 18-44 have the lowest percentage of physician office visits than any other age group, younger or older. However, early adulthood seems to be a particularly risky time for violent deaths (rates vary by gender, race, and ethnicity). The leading causes of death for both age groups 15-24 and 25-34 in the U.S. are unintentional injury, suicide, and homicide. Cancer and heart disease follows as the fourth and fifth top causes of death among young adults.

Substance Abuse
Rates of violent death are influenced by substance abuse, which peaks during early adulthood. Some young adults use drugs and alcohol as a way of coping with stress from family, personal relationships, or concerns over being on one’s own. Others “use” because they have friends who use and in the early 20s, there is still a good deal of pressure to conform. Youth transitioning into adulthood have some of the highest rates of alcohol and substance abuse. For instance, rates of binge drinking (drinking five or more drinks on a single occasion) in 2014 were: 28.5 percent for people ages 18 to 20 and 43.3 percent for people ages 21-25. Recent data from the Centers for Disease Control and Prevention show increases in drug overdose deaths between 2006 and 2016 (with higher rates among males), but with the steepest increases between 2014 and 2016 occurring among males aged 24-34 and females aged 24-34 and 35-44. Rates vary by other factors including race and geography; increased use and abuse of opioids may also play a role.

Drugs impair judgment, reduce inhibitions, and alter mood, all of which can lead to dangerous behavior. Reckless driving, violent altercations, and forced sexual encounters are some examples. College campuses are notorious for binge drinking, which is particularly concerning since alcohol plays a role in over half of all student sexual assaults. Alcohol is involved nearly 90 percent of the time in acquaintance rape (when the perpetrator knows the victim). Over 40 percent of sexual assaults involve alcohol use by the victim and almost 70 percent involve alcohol use by the perpetrator.

Drug and alcohol use increase the risk of sexually transmitted infections because people are more likely to engage in risky sexual behavior when under the influence. This includes having sex with someone who has had multiple partners, having anal sex without the use of a condom, having multiple partners, or having sex with someone whose history is unknown. Such risky sexual behavior puts individuals at increased risk for both sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). STDs are especially common among young people. There are about 20 million new cases of STDs each year in the United States and about half of those infections are in people between the ages of 15 and 24. Also, young people are the most likely to be unaware of their HIV infection, with half not knowing they have the virus.

Sexual Responsiveness and Reproduction in Early Adulthood
Sexual Responsiveness
Men and women tend to reach their peak of sexual responsiveness at different ages. For men, sexual responsiveness tends to peak in the late teens and early twenties. Sexual arousal can easily occur in response to physical stimulation or fantasizing. Sexual responsiveness begins a slow decline in the late twenties and into the thirties although a man may continue to be sexually active throughout adulthood. Over time, a man may require more intense stimulation in order to become aroused. Women often find that they become more sexually responsive throughout their 20s and 30s and may peak in the late 30s or early 40s. This is likely due to greater self-confidence and reduced inhibitions about sexuality.

There are a wide variety of factors that influence sexual relationships during emerging adulthood; this includes beliefs about certain sexual behaviors and marriage. For example, among emerging adults in the United States, it is common for oral sex to not be considered “real sex”. In the 1950s and 1960s, about 75 percent of people between the ages of 20–24 engaged in premarital sex; today, that number is 90 percent. Unintended pregnancy and sexually transmitted infections and diseases (STIs/STDs) are a central issue. As individuals move through emerging adulthood, they are more likely to engage in monogamous sexual relationships and practice safe sex.

Reproduction
For many couples, early adulthood is the time for having children. However, delaying childbearing until the late 20s or early 30s has become more common in the United States. The mean age of first-time mothers in the United States increased 1.4 years, from 24.9 in 2000 to 26.3 in 2014. This shift can primarily be attributed to a larger number of first births to older women along with fewer births to mothers under age 20.

Couples delay childbearing for a number of reasons. Women are now more likely to attend college and begin careers before starting families. And both men and women are delaying marriage until they are in their late 20s and early 30s. In 2018, the average age for a first marriage in the United States was 29.8 for men and 27.8 for women.

Infertility
Infertility affects about 6.7 million women or 11 percent of the reproductive age population. Male factors create infertility in about a third of the cases. For men, the most common cause is a lack of sperm production or low sperm production. Female factors cause infertility in another third of cases. For women, one of the most common causes of infertility is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease (PID) or endometriosis. PID is experienced by 1 out of 7 women in the United States and leads to infertility about 20 percent of the time. One of the major causes of PID is Chlamydia, the most commonly diagnosed sexually transmitted infection in young women. Another cause of pelvic inflammatory disease is gonorrhea. Both male and female factors contribute to the remainder of cases of infertility and approximately 20 percent are unexplained.

Fertility Treatment
The majority of infertility cases (85-90 percent) are treated using fertility drugs to increase ovulation or with surgical procedures to repair the reproductive organs or remove scar tissue from the reproductive tract. In vitro fertilization (IVF) is used to treat infertility in less than 5 percent of cases. IVF is used when a woman has blocked or deformed fallopian tubes or sometimes when a man has a very low sperm count. This procedure involves removing eggs from the female and fertilizing the eggs outside the woman’s body. The fertilized egg is then reinserted in the woman’s uterus. The average cost of an IVF cycle in the U.S. is $10,000-15,000 and the average live delivery rate for IVF in 2005 was 31.6 percent per retrieval. IVF makes up about 99 percent of artificial reproductive procedures.

Less common procedures include gamete intrafallopian tube transfer (GIFT) which involves implanting both sperm and ova into the fallopian tube and fertilization is allowed to occur naturally. Zygote intrafallopian tube transfer (ZIFT) is another procedure in which sperm and ova are fertilized outside of the woman’s body and the fertilized egg or zygote is then implanted in the fallopian tube. This allows the zygote to travel down the fallopian tube and embed in the lining of the uterus naturally.

Insurance coverage for infertility is required in fourteen states, but the amount and type of coverage available vary greatly. The majority of couples seeking treatment for infertility pay much of the cost. Consequently, infertility treatment is much more accessible to couples with higher incomes. However, grants and funding sources may be available for lower-income couples seeking infertility treatment.

Fertility for Singles and Same-Sex Couples
The journey to parenthood may look different for singles same-sex couples. However, there are several viable options available to them to have their own biological children. Men and women may choose to donate their sperm or eggs to help others reproduce for monetary or humanitarian reasons. Some gay couples may decide to have a surrogate pregnancy. One or both of the men would provide the sperm and choose a carrier. The chosen woman may be the source of the egg and uterus or the woman could be a third party that carries the created embryo.

Reciprocal IVF is used by couples who both possess female reproductive organs. Using in vitro fertilization, eggs are removed from one partner to be used to make embryos that the other partner will hopefully carry in a successful pregnancy.

Artificial insemination (AI) is the deliberate introduction of sperm into a female’s cervix or uterine cavity for the purpose of achieving a pregnancy through in vivo fertilization by means other than sexual intercourse. AI is most often used by single women who desire to give birth to their own child, women who are in a lesbian relationship, or women who are in a heterosexual relationship but with a male partner who is infertile or who has a physical impairment that prevents intercourse. The sperm used could be anonymous or from a known donor.

What you’ll learn to do: explain cognitive development in early adulthood
A woman shown at her desk, deep in thought with a notebook open in front of her
We have learned about cognitive development from infancy through adolescence, ending with Piaget’s stage of formal operations. Does that mean that cognitive development stops with adolescence? Couldn’t there be different ways of thinking in adulthood that come after (or “post”) formal operations?

In this section, we will learn about these types of postformal operational thought and consider research done by William Perry related to types of thought and advanced thinking. We will also look at education in early adulthood, the relationship between education and work, and some tools used by young adults to choose their careers.

Cognitive Development in Early Adulthood
Beyond Formal Operational Thought: Postformal Thought
In the adolescence module, we discussed Piaget’s formal operational thought. The hallmark of this type of thinking is the ability to think abstractly or to consider possibilities and ideas about circumstances never directly experienced. Thinking abstractly is only one characteristic of adult thought, however. If you compare a 14-year-old with someone in their late 30s, you would probably find that the latter considers not only what is possible, but also what is likely. Why the change? The young adult has gained experience and understands why possibilities do not always become realities. This difference in adult and adolescent thought can spark arguments between the generations.

Following is an example. A student in her late 30s relayed such an argument she was having with her 14-year-old son. The son had saved a considerable amount of money and wanted to buy an old car and store it in the garage until he was old enough to drive. He could sit in it, pretend he was driving, clean it up, and show it to his friends. It sounded like a perfect opportunity. The mother, however, had practical objections. The car would just sit for several years while deteriorating. The son would probably change his mind about the type of car he wanted by the time he was old enough to drive and they would be stuck with a car that would not run. She was also concerned that having a car nearby would be too much temptation and the son might decide to sneak it out for a quick ride before he had a permit or license.

Piaget’s theory of cognitive development ended with formal operations, but it is possible that other ways of thinking may develop after (or “post”) formal operations in adulthood (even if this thinking does not constitute a separate “stage” of development). Postformal thought is practical, realistic, and more individualistic, but also characterized by understanding the complexities of various perspectives. As a person approaches the late 30s, chances are they make decisions out of necessity or because of prior experience and are less influenced by what others think. Of course, this is particularly true in individualistic cultures such as the United States. Postformal thought is often described as more flexible, logical, willing to accept moral and intellectual complexities, and dialectical than previous stages in development.

Perry’s Scheme

Perry’s Scheme of intellectual development proposes nine positions or levels with the transformative sequences that connect them. Googling William G. Perry or Perry’s Scheme (be sure to add the middle initial to avoid being inundated with links to William “Refrigerator” Perry, the former NFL lineman) will provide a number of summaries of his model, which is often reduced to four levels:

One of the first theories of cognitive development in early adulthood originated with William Perry, who studied undergraduate students at Harvard University. Perry noted that over the course of students’ college years, cognition tended to shift from dualism (absolute, black and white, right and wrong type of thinking) to multiplicity (recognizing that some problems are solvable and some answers are not yet known) to relativism (understanding the importance of the specific context of knowledge—it’s all relative to other factors). Similar to Piaget’s formal operational thinking in adolescence, this change in thinking in early adulthood is affected by educational experiences.

Dialectical Thought
In addition to moving toward more practical considerations, thinking in early adulthood may also become more flexible and balanced. Abstract ideas that the adolescent believes in firmly may become standards by which the individual evaluates reality. As Perry’s research pointed out, adolescents tend to think in dichotomies or absolute terms; ideas are true or false; good or bad; right or wrong and there is no middle ground. However, with education and experience, the young adult comes to recognize that there are some right and some wrong in each position. Such thinking is more realistic because very few positions, ideas, situations, or people are completely right or wrong.

Some adults may move even beyond the relativistic or contextual thinking described by Perry; they may be able to bring together important aspects of two opposing viewpoints or positions, synthesize them, and come up with new ideas. This is referred to as dialectical thought and is considered one of the most advanced aspects of postformal thinking (Basseches, 1984). There isn’t just one theory of postformal thought; there are variations, with emphasis on adults’ ability to tolerate ambiguity or to accept contradictions or find new problems, rather than solve problems, etc. (as well as relativism and dialecticism that we just learned about). What they all have in common is the proposition that the way we think may change during adulthood with education and experience.

Parenting
Having Children
Do you want children? Do you already have children? Increasingly, families are postponing or not having children. Families that choose to forego having children are known as childfree families, while families that want but are unable to conceive are referred to as childless families. As more young people pursue their education and careers, age at first marriage has increased; similarly, so has the age at which people become parents. With a college degree, the average age for women to have their first child is 30.3, but without a college degree, the average age is 23.8. Marital status is also related, as the average age for married women to have their first child is 28.8, while the average age for unmarried women is 23.1. Overall, the average age of first-time mothers has increased to 26, up from 21 in 1972, and the average age of first-time fathers has increased to 31, up from 27 in 1972 in the United States. The age of first-time parents in the U.S. increased sharply in the 1970s after abortion was legalized. Since the age of first-time parents varies by geographic region in the U.S. and women’s rights to abortion are being challenged in some states, it will be interesting to follow the norms and trends for first-time parents in the future.

The decision to become a parent should not be taken lightly. There are positives and negatives associated with parenting that should be considered. Many parents report that having children increases their well-being. Researchers have also found that parents, compared to their non-parent peers, are more positive about their lives. On the other hand, researchers have also found that parents, compared to non-parents, are more likely to be depressed, report lower levels of marital quality, and feel like their relationship with their partner is more businesslike than intimate.

If you do become a parent, your parenting style will impact your child’s future success in romantic and parenting relationships. Recall from the module on early childhood that there are several different parenting styles. Authoritative parenting, arguably the best parenting style, is both demanding and supportive of the child. Support refers to the amount of affection, acceptance, and warmth a parent provides. Demandingness refers to the degree a parent controls their child’s behavior. Children who have authoritative parents are generally happy, capable, and successful.

Other, less advantageous parenting styles include authoritarian (in contrast to authoritative), permissive, and uninvolved. Authoritarian parents are low in support and high in demandingness. Arguably, this is the parenting style used by Harry Potter’s harsh aunt and uncle, and Cinderella’s vindictive stepmother. Children who receive authoritarian parenting are more likely to be obedient and proficient but score lower in happiness, social competence, and self-esteem. Permissive parents are high in support and low in demandingness. Their children rank low in happiness and self-regulation and are more likely to have problems with authority. Uninvolved parents are low in both support and demandingness. Children of these parents tend to rank lowest across all life domains, lack self-control, have low self-esteem, and are less competent than their peers.

Support for the benefits of authoritative parenting has been found in countries as diverse as the Czech Republic, China, and Palestine. In fact, authoritative parenting appears to be superior in Western, individualistic societies—so much so that some people have argued that there is no longer a need to study it. Other researchers are less certain about the superiority of authoritative parenting and point to differences in cultural values and beliefs. For example, while many European-American children do poorly with too much strictness (authoritarian parenting), Chinese children often do well, especially academically. The reason for this likely stems from Chinese culture viewing strictness in parenting as related to training, which is not central to American parenting.

Class and Culture
The impact of class and culture cannot be ignored when examining parenting styles. It is assumed that authoritative styles are best because they are designed to help the parent raise a child who is independent, self-reliant, and responsible. These are qualities favored in “individualistic” cultures such as the United States, particularly by the middle class.

Authoritarian parenting has been used historically and reflects the cultural need for children to do as they are told. African-American, Hispanic, and Asian parents tend to be more authoritarian than non-Hispanic whites. In collectivistic cultures such as China or Korea, being obedient and compliant are favored behaviors. In societies where family members’ cooperation is necessary for survival, as in the case of raising crops, rearing children who are independent and who strive to be on their own makes no sense. But in an economy based on being mobile in order to find jobs and where one’s earnings are based on education, raising a child to be independent is very important.

Working-class parents are more likely than middle-class parents to focus on obedience and honesty when raising their children. In a classic study on social class and parenting styles called Class and Conformity, Kohn (1977) explained that parents tend to emphasize qualities that are needed for their own survival when parenting their children. Working-class parents are rewarded for being obedient, reliable, and honest in their jobs. They are not paid to be independent or to question the management; rather, they move up and are considered good employees if they show up on time, do their work as they are told, and can be counted on by their employers. Consequently, these parents reward honesty and obedience in their children. Middle-class parents who work as professionals are rewarded for taking initiative, being self-directed, and assertive in their jobs. They are required to get the job done without being told exactly what to do. They are asked to be innovative and to work independently. These parents encourage their children to have those qualities as well by rewarding independence and self-reliance. Parenting styles can reflect many elements of culture.

The Development of Parents
Think back to an emotional event you experienced as a child. How did your parents react to you? Did your parents get frustrated or criticize you, or did they act patiently and provide support and guidance? Did your parents provide lots of rules for you or let you make decisions on your own? Why do you think your parents behaved the way they did?

Psychologists have attempted to answer these questions about the influences on parents and understand why parents behave the way they do. Because parents are critical to a child’s development, a great deal of research has been focused on the impact that parents have on children. Less is known, however, about the development of parents themselves and the impact of children on parents. Nonetheless, parenting is a major role in an adult’s life. Parenthood is often considered a normative developmental task of adulthood. Cross-cultural studies show that adolescents around the world plan to have children. In fact, most men and women in the United States will become parents by the age of 40 years.

People have children for many reasons, including emotional reasons (e.g., the emotional bond with children and the gratification the parent-child relationship brings), economic and utilitarian reasons (e.g., children provide help in the family and support in old age), and social-normative reasons (e.g., adults are expected to have children; children provide status).

The Changing Face of Parenthood
Parenthood is undergoing changes in the United States and elsewhere in the world. Children are less likely to be living with both parents, and women in the United States have fewer children than they did previously. The average fertility rate of women in the United States was about seven children in the early 1900s and has remained relatively stable at 2.1 since the 1970s. Not only are parents having fewer children, but the context of parenthood has also changed. Parenting outside of marriage has increased dramatically among most socioeconomic, racial, and ethnic groups, although college-educated women are substantially more likely to be married at the birth of a child than are mothers with less education. Parenting is occurring outside of marriage for many reasons, both economic and social. People are having children at older ages, too. Despite the fact that young people are more often delaying childbearing, most 18- to 29-year-olds want to have children and say that being a good parent is one of the most important things in life.

Galinsky (1987) was one of the first to emphasize the development of parents themselves, how they respond to their children’s development, and how they grow as parents. Parenthood is an experience that transforms one’s identity as parents take on new roles. Children’s growth and development force parents to change their roles. They must develop new skills and abilities in response to children’s development. Galinsky identified six stages of parenthood that focus on different tasks and goals (see Table 2).

1. The Image-Making Stage
   As prospective parents think about and form images about their roles as parents and what parenthood will bring, and prepare for the changes an infant will bring, they enter the image-making stage. Future parents develop their ideas about what it will be like to be a parent and the type of parent they want to be. Individuals may evaluate their relationships with their own parents as a model of their roles as parents.
2. The Nurturing Stage
   The second stage, the nurturing stage, occurs at the birth of the baby. A parent’s main goal during this stage is to develop an attachment relationship with their baby. Parents must adapt their romantic relationships, their relationships with their other children, and with their own parents to include the new infant. Some parents feel attached to the baby immediately, but for other parents, this occurs more gradually. Parents may have imagined their infant in specific ways, but they now have to reconcile those images with their actual baby. In incorporating their relationship with their child into their other relationships, parents often have to reshape their conceptions of themselves and their identity. Parenting responsibilities are the most demanding during infancy because infants are completely dependent on caregiving.
3. The Authority Stage
   The authority stage occurs when children are 2 years old until about 4 or 5 years old. In this stage, parents make decisions about how much authority to exert over their children’s behavior. Parents must establish rules to guide their child’s behavior and development. They have to decide how strictly they should enforce rules and what to do when rules are broken.
4. The Interpretive Stage
   The interpretive stage occurs when children enter school (preschool or kindergarten) to the beginning of adolescence. Parents interpret their children’s experiences as children are increasingly exposed to the world outside the family. Parents answer their children’s questions, provide explanations, and determine what behaviors and values to teach. They decide what experiences to provide their children, in terms of schooling, neighborhood, and extracurricular activities. By this time, parents have experience in the parenting role and often reflect on their strengths and weaknesses as parents, review their images of parenthood, and determine how realistic they have been. Parents have to negotiate how involved to be with their children, when to step in, and when to encourage children to make choices independently.
5. The Interdependent Stage
   Parents of teenagers are in the interdependent stage. They must redefine their authority and renegotiate their relationship with their adolescent as the children increasingly make decisions independent of parental control and authority. On the other hand, parents do not permit their adolescent children to have complete autonomy over their decision-making and behavior, and thus adolescents and parents must adapt their relationship to allow for greater negotiation and discussion about rules and limits.
6. The Departure Stage
   During the departure stage of parenting, parents evaluate the entire experience of parenting. They prepare for their child’s departure, redefine their identity as the parent of an adult child, and assess their parenting accomplishments and failures. This stage forms a transition to a new era in parents’ lives. This stage usually spans a long time period from when the oldest child moves away (and often returns) until the youngest child leaves. The parenting role must be redefined as a less central role in a parent’s identity.

Despite the interest in the development of parents among laypeople and helping professionals, little research has examined developmental changes in parents’ experience and behaviors over time. Thus, it is not clear whether these theoretical stages are generalizable to parents of different races, ages, and religions, nor do we have empirical data on the factors that influence individual differences in these stages. On a practical note, how-to books and websites geared toward parental development should be evaluated with caution, as not all advice provided is supported by research.

Influences on Parenting
Parenting is a complex process in which parents and children influence one another. There are many reasons that parents behave the way they do. The multiple influences on parenting are still being explored. Proposed influences on parental behavior include 1) parent characteristics, 2) child characteristics, and 3) contextual and sociocultural characteristics.

Parent Characteristics
Parents bring unique traits and qualities to the parenting relationship that affect their decisions as parents. These characteristics include the age of the parent, gender, beliefs, personality, developmental history, knowledge about parenting and child development, and mental and physical health. Parents’ personalities affect parenting behaviors. Mothers and fathers who are more agreeable, conscientious, and outgoing are warmer and provide more structure to their children. Parents who are more agreeable, less anxious, and less negative also support their children’s autonomy more than parents who are anxious and less agreeable. Parents who have these personality traits appear to be better able to respond to their children positively and provide a more consistent, structured environment for their children.

Parents’ developmental histories, or their experiences as children, also affect their parenting strategies. Parents may learn parenting practices from their own parents. Fathers whose own parents provided monitoring, consistent and age-appropriate discipline, and warmth were more likely to provide this constructive parenting to their own children. Patterns of negative parenting and ineffective discipline also appear from one generation to the next. However, parents who are dissatisfied with their own parents’ approach may be more likely to change their parenting methods with their own children.

Child Characteristics
Parenting is bidirectional. Not only do parents affect their children, but children also influence their parents. Child characteristics, such as gender, birth order, temperament, and health status, affect parenting behaviors and roles. For example, an infant with an easy temperament may enable parents to feel more effective, as they are easily able to soothe the child and elicit smiling and cooing. On the other hand, a cranky or fussy infant elicits fewer positive reactions from his or her parents and may result in parents feeling less effective in the parenting role. Over time, parents of more difficult children may become more punitive and less patient with their children. Parents who have a fussy, difficult child are less satisfied with their marriages and have greater challenges in balancing work and family roles. Thus, child temperament is one of the child characteristics that influences how parents behave with their children.

Another child characteristic is the gender of the child. Parents respond differently to boys and girls. Parents often assign different household chores to their sons and daughters. Girls are more often responsible for caring for younger siblings and household chores, whereas boys are more likely to be asked to perform chores outside the home, such as mowing the lawn. Parents also talk differently with their sons and daughters, providing more scientific explanations to their sons and using more emotion words with their daughters.

Contextual Factors and Sociocultural Characteristics
The parent-child relationship does not occur in isolation. Sociocultural characteristics, including economic hardship, religion, politics, neighborhoods, schools, and social support, also influence parenting. Parents who experience economic hardship are more easily frustrated, depressed, and sad, and these emotional characteristics affect their parenting skills. Culture also influences parenting behaviors in fundamental ways. Although promoting the development of skills necessary to function effectively in one’s community is a universal goal of parenting, the specific skills necessary vary widely from culture to culture. Thus, parents have different goals for their children that partially depend on their culture. For example, parents vary in how much they emphasize goals for independence and individual achievements, and goals involving maintaining harmonious relationships and being embedded in a strong network of social relationships. These differences in parental goals are influenced by culture and by immigration status. Other important contextual characteristics, such as the neighborhood, school, and social networks, also affect parenting, even though these settings don’t always include both the child and the parent. For example, Latina mothers who perceived their neighborhood as more dangerous showed less warmth with their children, perhaps because of the greater stress associated with living a threatening environment. Many contextual factors influence parenting.

Figure 1. Influences on parenting include characteristics of the parent and child, as well as the context and world around them.

Child Care Concerns
About 75.7 percent of mothers of school-aged and 65.1 percent of mothers of preschool-aged children in the United States work outside the home. Since more women have been entering the workplace, there has been a concern that families do not spend as much time with their children. This, however, may not be true. Between 1981 and 1997, the amount of time that parents spent with children increased overall. Modern numbers for this vary widely, as many parents who work outside of the home also devote significant amounts of time to childcare, to 14 hours a week, compared with 10 in 1965. The amount of this time that is undistracted and involved may be close to 34 minutes a day.

Seventy-five percent of children under age 5 are in scheduled child care programs. Others are cared for by family members, friends, or are in Head Start Programs. Older children are often in after school programs, before school programs, or stay at home alone after school once they are older. Quality childcare programs can enhance a child’s social skills and can provide rich learning experiences. But long hours in poor quality care can have negative consequences for young children in particular. What determines the quality of child care? One very important consideration is the teacher/child ratio. States specify the maximum number of children that can be supervised by one teacher. In general, the younger the children, the more teachers required for a given number of children. The lower the teacher to child ratio, the more time the teacher has for involvement with the children and the less stressed the teacher may be so that the interactions can be more relaxed, stimulating, and positive. The more children there are in a program, the less desirable the program as well. This is because the center may be more rigid in rules and structure to accommodate a large number of children in the facility.

The physical environment should be colorful, stimulating, clean, and safe. The philosophy of the organization and the curriculum available should be child-centered, positive, and stimulating. Providers should be trained in early childhood education as well. A majority of states do not require training for their child care providers. And while a formal education is not required for a person to provide a warm, loving relationship to a child, knowledge of a child’s development is useful for addressing their social, emotional, and cognitive needs in an effective way. By working toward improving the quality of childcare and increasing family-friendly workplace policies, such as more flexible scheduling and perhaps childcare facilities at places of employment, we can accommodate families with smaller children and relieve parents of the stress sometimes associated with managing work and family life.

Learning and Behavior Modification
Parenting and Behaviorism
Parenting generally involves many opportunities to apply principles of behaviorism, especially operant conditioning. In discussing operant conditioning, we use several everyday words—positive, negative, reinforcement, and punishment—in a specialized manner. In operant conditioning, positive and negative do not mean good and bad. Instead, positive means you are adding something, and negative means you are taking something away. Reinforcement means you are increasing a behavior, and punishment means you are decreasing a behavior. Reinforcement can be positive or negative, and punishment can also be positive or negative. All reinforcers (positive or negative) increase the likelihood of a behavioral response. All punishers (positive or negative) decrease the likelihood of a behavioral response. Now let’s combine these four terms: positive reinforcement, negative reinforcement, positive punishment, and negative punishment. (See table below.)

Table 4. Positive and Negative Reinforcement and Punishment

The most effective way to teach a person or animal a new behavior is with positive reinforcement. In positive reinforcement, a stimulus is added to the situation to increase a behavior. Parents and teachers use positive reinforcement all the time, from offering dessert after dinner, praising children for cleaning their room or completing some work, offering a toy at the end of a successful piano recital, or earning more time for recess. The goal of providing these forms of positive reinforcement is to increase the likelihood of the same behavior occurring in the future.

Positive reinforcement is an extremely effective learning tool, as evidenced by nearly 80 years worth of research. That said, there are many ways to introduce positive reinforcement into a situation. Many people believe that reinforcers must be tangible, but research shows that verbal praise and hugs are very effective reinforcers for people of all ages. Further, research suggests that constantly providing tangible reinforcers may actually be counterproductive in certain situations. For example, paying children for their grades may undermine their intrinsic motivation to go to school and do well. While children who are paid for their grades may maintain good grades, it is to receive the reinforcing pay, not because they have an intrinsic desire to do well. The impact is especially detrimental to students who initially have a high level of intrinsic motivation to do well in school. Therefore, we must provide appropriate reinforcement, and be careful to ensure that the reinforcement does not undermine intrinsic motivation.

In negative reinforcement, an aversive stimulus is removed to increase a behavior. For example, car manufacturers use the principles of negative reinforcement in their seatbelt systems, which go “beep, beep, beep” until you fasten your seatbelt. The annoying sound stops when you exhibit the desired behavior, increasing the likelihood that you will buckle up in the future. Negative reinforcement is also used frequently in horse training. Riders apply pressure—by pulling the reins or squeezing their legs—and then remove the pressure when the horse performs the desired behavior, such as turning or speeding up. The pressure is the negative stimulus that the horse wants to remove.

Sometimes, adding something to the situation is reinforcing as in the cases we described above with cookies, praise, and money. Positive reinforcement involves adding something to the situation in order to encourage a behavior. Other times, taking something away from a situation can be reinforcing. For example, the loud, annoying buzzer on your alarm clock encourages you to get up so that you can turn it off and get rid of the noise. Children whine in order to get their parents to do something and often, parents give in just to stop the whining. In these instances, children have used negative reinforcement to get what they want.

Operant conditioning tends to work best if you focus on encouraging a behavior or moving a person into the direction you want them to go rather than telling them what not to do. Reinforcers are used to encourage behavior; punishers are used to stop the behavior. A punisher is anything that follows an act and decreases the chance it will reoccur. As with reinforcement, there are also two types of punishment: positive and negative.

Positive punishment involves adding something in order to decrease the likelihood that a behavior will occur again in the future. Spanking is an example of positive punishment. Receiving a speeding ticket is also an example of positive punishment. Both of these punishers, the spanking and the speeding ticket, are intended to decrease the reoccurrence of the related behavior.

Negative punishment involves removing something that is desired in order to decrease the likelihood that a behavior will occur again in the future. Putting a child in time out can serve as a negative punishment if the child enjoys social interaction. Taking away a child’s technology privileges can also be a negative punishment. Taking away something desired encourages the child to refrain from engaging in that behavior again to avoid losing the desired object or activity.

Often, punished behavior doesn’t really go away. It is just suppressed and may reoccur whenever the threat of punishment is removed. For example, a child may not cuss around you because you’ve washed his mouth out with soap, but he may cuss around his friends. A motorist may only slow down when the trooper is on the side of the freeway. Another problem with punishment is that when a person focuses on punishment, they may find it hard to see what the other does right or well. Punishment is stigmatizing; when punished, some people start to see themselves as bad and give up trying to change.

Reinforcement can occur in a predictable way, such as after every desired action is performed (called continuous reinforcement), or intermittently, after the behavior is performed a number of times or the first time it is performed after a certain amount of time (called partial reinforcement whether based on the number of times or the passage of time). The schedule of reinforcement has an impact on how long a behavior continues after reinforcement is discontinued. So a parent who has rewarded a child’s actions each time may find that the child gives up very quickly if a reward is not immediately forthcoming. Children will learn quickest under a continuous schedule of reinforcement. Then the parent should switch to a partial reinforcement schedule to maintain the behavior.

Everyday Connection: Behavior Modification in Children
Parents and teachers often use behavior modification to change a child’s behavior. Behavior modification uses the principles of operant conditioning to accomplish behavior change so that undesirable behaviors are switched for more socially acceptable ones. Some teachers and parents create a sticker chart, in which several behaviors are listed. Sticker charts are a form of token economies. Each time children perform the behavior, they get a sticker, and after a certain number of stickers, they get a prize or reinforcer. The goal is to increase acceptable behaviors and decrease misbehavior. Remember, it is best to reinforce desired behaviors, rather than to use punishment. In the classroom, the teacher can reinforce a wide range of behaviors, from students raising their hands to walking quietly in the hall, to turning in their homework. Parents might create a behavior chart at home that rewards children for things such as putting away toys, brushing their teeth, and helping with dinner. For behavior modification to be effective, the reinforcement needs to be connected with the behavior; the reinforcement must matter to the child and be provided consistently.

Time-out is another popular technique used in behavior modification with children. It operates on the principle of negative punishment. When a child demonstrates an undesirable behavior, she is removed from the desirable activity at hand. For example, say that Sophia and her brother Mario are playing with building blocks. Sophia throws some blocks at her brother, so you give her a warning that she will go to time-out if she does it again. A few minutes later, she throws more blocks at Mario. You remove Sophia from the room for a few minutes. When she comes back, she doesn’t throw blocks.

There are several important points that you should know if you plan to implement time-out as a behavior modification technique. First, ensure the child is removed from a desirable activity and placed in a less desirable location. If the activity is something undesirable for the child, this technique will backfire because it is more enjoyable for the child to be removed from the activity. Second, the length of the time-out is important. The general rule of thumb is one minute for each year of the child’s age. Sophia is five; therefore, she sits in a time-out for five minutes. Setting a timer helps children know how long they have to sit in time-out. Finally, as a caregiver, keep several guidelines in mind over the course of a time-out: remain calm when directing your child to time-out; ignore your child during a time-out (because caregiver attention may reinforce misbehavior), and give the child a hug or a kind word when time-out is over.

Do parents socialize children or do children socialize parents?
Bandura’s findings suggest that there is interplay between the environment and the individual. We are not just the product of our surroundings, rather we influence our surroundings. There is an interplay between our personality, how we interpret events, and how they influence us. This concept is called reciprocal determinism. An example of this might be the interplay between parents and children. Parents not only influence their child’s environment, perhaps intentionally through the use of reinforcement, etc., but children influence parents as well. Parents may respond differently to their first child than with their fourth. Perhaps they try to be the perfect parents with their firstborn, but by the time their last child comes along, they have very different expectations of themselves and their child. Our environment creates us and we create our environment. Today there are numerous other social influences, from TV, games, the Internet, i-pads, phones, social media, influencers, advertisements, etc.

Theories of Early Adult Psychosocial Development
Gaining Adult Status
Many of the developmental tasks of early adulthood involve becoming part of the adult world and gaining independence. Young adults sometimes complain that they are not treated with respect, especially if they are put in positions of authority over older workers. Consequently, young adults may emphasize their age to gain credibility from even slightly younger people. “You’re only 23? I’m 27!” a young adult might exclaim.

The focus of early adulthood is often on the future. Many aspects of life are on hold while people go to school, go to work, and prepare for a brighter future. There may be a belief that the hurried life now lived will improve ‘as soon as I finish school’ or ‘as soon as I get promoted’ or ‘as soon as the children get a little older.’ As a result, time may seem to pass rather quickly. The day consists of meeting many demands that these tasks bring. The incentive for working so hard is that it will all result in a better future.

Levinson’s Theory
In 1978, Daniel Levinson published a book entitled, The Seasons of a Man’s Life in which he presented a theory of development in adulthood. Levinson’s work was based on in-depth interviews with 40 men between the ages of 35-45. According to Levinson, young adults have an image of the future that motivates them. This image is called “the dream” and for the men interviewed, it was a dream of how their career paths would progress and where they would be at midlife. Dreams are very motivating. Dreams of a home bring excitement to couples as they look, save, and fantasize about how life will be. Dreams of careers motivate students to continue in school as they fantasize about how much their hard work will pay off. Dreams of playgrounds on a summer day inspire would-be parents. A dream is perfect and retains that perfection as long as it remains in the future. But as the realization of it moves closer, it may or may not measure up to its image. If it does, all is well. But if it does not, the image must be replaced or modified. And so, in adulthood, plans are made, efforts follow, and plans are reevaluated. This creating and recreating characterizes Levinson’s theory. (The shift from idealistic dreams to more realistic experiences might remind us of the cognitive development progression from formal to postformal thought in adulthood.)

Levinson’s stages (at least up to midlife) are presented below. He suggested that periods of transition last about five years and periods of stability last about seven years. The ages presented below are based on life in the middle-class several decades ago. Think about how these ages and transitions might be different today, or in other cultures, or for women compared to men.

-Early adult transition (17-22): Leaving home, leaving family; making first choices about career and education
-Entering the adult world (22-28): Committing to an occupation, defining goals, finding intimate relationships
-Age 30 transition (28-33): Reevaluating those choices and perhaps making modifications or changing one’s attitude toward love and work
-Settling down (33 to 40): Reinvesting in work and family commitments; becoming involved in the community
-Midlife transition (40-45): Reevaluating previous commitments; making dramatic changes if necessary; giving expression to previously ignored talents or aspirations; feeling more of a sense of urgency about life and its meaning
-Entering middle adulthood (45-50): Committing to new choices made and placing one’s energies into these commitments

Nearly twenty years after his original research, Levinson interviewed 45 women ages 35-45 and published the book, The seasons of a woman’s life. He reported similar patterns with women, although women held a “split dream”—an image of the future in both work and family life and a concern with the timing and coordination of the two. Traditionally, by working outside the home, men were seen as taking care of their families. However, for women, working outside the home and taking care of their families were perceived as separate and competing for their time and attention. Hence, one aspect of the women’s dreams was focused on one goal for several years and then their time and attention shifted towards the other, often resulting in delays in women’s career dreams.

Adulthood is a period of building and rebuilding one’s life. Many decisions in early adulthood are made before a person has had enough experience to really understand the consequences of such decisions. And, perhaps, many of these initial decisions are made with one goal in mind – to be seen as an adult. As a result, early decisions may be driven more by the expectations of others. For example, imagine someone who chose a career path based on other’s advice but now finds that the job is not what was expected.

The age 30 transition may involve recommitting to the same job, not because it’s stimulating, but because it pays well; or the person may decide to return to school and change careers. Settling down may involve settling down with a new set of expectations. As the adult gains status, he or she may be freer to make more independent choices. And sometimes these are very different from those previously made. The midlife transition differs from the age 30 transition in that the person is more aware of how much time has gone by and how much time is left. This brings a sense of urgency and impatience about making changes. The future focus of early adulthood gives way to an emphasis on the present in midlife–we will explore this in our next module. Overall, Levinson calls our attention to the dynamic nature of adulthood.

Young adults are often in the “prime of life,” especially physically and sexually. However, young adults may be engaged in risky behaviors and be particularly vulnerable to injuries, accidents, alcohol, and drug use/abuse, sexually transmitted diseases, rape, and suicide. Nutrition and exercise habits in this stage are important since they are associated with health and certain illnesses in middle age. Cognitive and brain development continues, with the influences of education and experience. Young adults may move from formal logical thinking to postformal thinking, becoming better at considering multiple perspectives and contexts, appreciating ambiguity and uncertainty, and using practical experience in making decisions.

Higher education plays an important role for more and more young adults—in this module we examined the connections between education and work and learned about how exploring and choosing one’s career is key during this stage. We saw that establishing intimacy in friendships, romance, and family relationships is another significant aspect of young adulthood; love, dating, cohabitation, marriage, and becoming parents were all examined.

We were introduced to the major theories of adult development, primarily those of Erikson and Levinson, and we learned about Arnett’s “emerging adulthood,” a potentially new stage involving the transition from adolescence to young adulthood, with young adults taking on “adult roles” later than expected. By the late thirties, though, most young adults have become independent of their parents/families of origin and are in the throes of adult work, family, and community activities and responsibilities.

Physical Changes
Females reach their adult heights by age 18, and, except for some males who continue to grow in their early 20s, most have reached their adult heights by the age of 21. However, muscles continue to gain mass – especially among males, and both genders continue to add body fat. Average weight gain for both women and men is about 15 pounds.

Death rates due to disease are low in this life stage, but the rate of violence-related deaths is high. A 2005 report by the Centers for Disease Control and Prevention (CDC) National Violent Death Reporting System states that violent death is highest for people ages 20 to 24, and overall, men are more likely than women to die violently. Violent death includes homicide, suicide and motor-vehicle deaths. The CDC reports that of approximately 50,000 violent deaths in the United States each year, more than 56 percent of those deaths are suicide, and 30 percent are homicides.

Another area of concern for people in this age group is eating disorders, which include anorexia nervosa, bulimia nervosa, and binge-eating disorder. A study by the National Association of Anorexia Nervosa and Associated Disorders reported that 5 percent to 10 percent of individuals with anorexia die within 10 years after contracting the disease, and 18 percent to 20 percent die after 20 years.

Cognitive Changes
Debate among developmentalists center on whether or not to assign a formal cognitive stage to early adulthood. Earlier life stages result in dramatic and critical changes, whereas in early adulthood essential brain growth already has taken place, and individuals are now applying and using their knowledge, and analytical capabilities.

However many researchers point to continued changes, such as those taking place in the frontal lobes of the cerebral cortex of the brain, which are areas where judgment, planning, speaking, and moving muscles are localized. Brain growth in this area only reaches final development in the early 20s.

Additionally, many theorists, such as Jean Piaget (1896-1980) noted a significant difference between adult and adolescent thinking. Adults have more flexibility in their thought patterns, understanding that there are multiple opinions on issues, and that there is more than one way to approach a problem.

Young adults are able to assimilate and synthesize complex and contradictory situations and arguments, and unlike adolescents, aren’t set on finding absolute truths. They are focused on developing their careers and achieving independence from their families – a crucial requirement for balanced, well functioning adults.

Emotional Changes.
Theorist Erik Erikson (1902-1994) maintained that individuals develop in psychosocial stages, and that early adulthood marks the time when individuals seek to form intimate relationships. And Sigmund Freud (1856-1939) argued that a healthy adult is one who can “love and work.” Simply stated, this developmental stage is characterized by relationships and work.

Intimacy can be actualized through close friendships, romantic relationships, starting a family, or all three. Erickson argued that a firm sense of identity, gained in earlier developmental stages, was integral to entering intimate relationships, and research has supported this argument. Studies repeatedly find that those lacking a strong sense of identity have less satisfactory relationships, and they tend to be more emotionally isolated, lonely and depressed.

And depression is a major concern for individuals in their 20s to mid-thirties: most people diagnosed with major depression receive a diagnosis in this life stage. Depression is linked to violence, especially suicide, and eating disorders.

The Eating Disorder Foundation asserts that “eating disorders are not just about food and weight. They are an attempt to use food intake and weight control to manage emotional conflicts that actually have little or nothing to do with food or weight.” The Foundation reports that eating disorders affect more women than men, about 10 million U.S. women, but the rates in men are rising. Approximately 1 million U.S. men suffer from an eating disorder, a number that has doubled in the last ten years.

And episodes of mild or severe depression in earlier developmental stages should not be minimized. A 2009 article in the British Journal of Psychiatry, found a link between mild adolescent depression and depression in early and later adulthood. The article cited a study that started in 1983, and followed teenagers, identified as having mood, anxiety and eating disorders, disruptive behaviors, and substance abuse problems, into their 20s and 30s. These teens reported significant, major depression in adulthood – and they were more likely to suffer from anxiety and eating disorders as adults.

References
open.maricopa.edu, “Early Adulthood.”; allpsychologycareers.com, “Early Adulthood Development Psychology.”; cse.buffalo.edu, “William Perry’s
Scheme of Intellectual and Ethical Development.” By William J. Rapaport;

Chapter 8–Middle-age Adults
Middle adulthood is a transitional phase in life. It ranges from ages 40-45 to 65, and it is characterized by a sense of freedom and autonomy as well as self-reflection.

Middle adulthood is the period of life between the young-adulthood stage and the elderly stage. It often starts from the late 20s or early 30s to what some might refer to as old age. Typically, middle adulthood begins with the prime earning years for most people, with the average worker typically reaching what might be considered their career peak somewhere in middle adulthood. Some researchers have defined the development of actual median age as occurring at around 45 years old. However, this varies from person to person based on what they have achieved throughout their life. Successful middle-aged people often have established careers and families while others complete their education and enter middle adulthood.

Middle adulthood is typically the most fulfilling period of a person’s life and is likely to experience what some refer to as their’ prime earning years. The average worker might reach their career peak in middle adulthood; however, this can vary from person to person based on what they have achieved throughout their life. In terms of middle adulthood development, a ‘Mid-life Crisis’ often occurs around the midpoint between young and late adulthood. This is a time when people question what they had earned so far, what others think of them, what accomplishments they may achieve, what was important to them when they were younger, and what they should do with the rest of their lives. This is often accompanied by changes in lifestyle, including what activities they should do, what career they may pursue, or what relationships can be entered into.

During this time, people experience many physical changes that signal that the person is aging, including gray hair and hair loss, wrinkles and age spots, vision and hearing loss, and weight gain, commonly called the middle age spread.

The term ‘Mid-life Crisis’ also refers to any significant, usually negative, change in a person’s life at the midpoint of young and late adulthood. This is often accompanied by “the now what?” feeling. At this point, there may be a need for a new identity, and it can sometimes lead to reckless behavior such as overindulgence of alcohol, drug use, or sexual promiscuity. However, the mid-life crisis differs from a ‘normal’ middle adulthood development stage. ‘Normal’ middle adulthood development refers to positive life changes, such as the ‘Second Adulthood,’ where an increased assertiveness can occur, where a ‘life review’ is often undertaken.

Life satisfaction has been found to increase with age, which can be considered as a positive sign for middle adulthood development. Some researchers have indicated that people reach a peak of emotional well-being in middle adulthood. In the most thorough longitudinal study of age and happiness conducted, it was found that there was a slight dip in what is referred to as ‘satisfaction with life’, which occurs during middle adulthood, indicating it to be around the age of 40. This was then followed by a ‘rebound’, an increase in satisfaction with life occurring right after middle adulthood.

Middle Adulthood Physical Development
Middle adulthood is between ages 40-65 for women and 50 to early 60s for men. This age bracket is known as middle adulthood because it occurs after young adulthood ends but before late adulthood begins. The physical changes experienced during this period are similar in both sexes, although their exact timing may differ. Middle Adulthood can last from 8 to 12 years; it changes one’s physical body and mental capacity. It is a big transition because it marks the beginning of the decline and death.

Physical changes in middle adulthood
Increase of muscle mass and size: Men at this age can grow up to 2 inches taller over five years; women might experience their growth spurt later than men because women produce estrogen, which makes them develop slower.
Problems with heart muscles or valves because of hypertension: Arteriosclerosis causes the walls of blood vessels to thicken and harden; this buildup can cut off the oxygen supply, which can cause a heart attack or stroke.
Loss of bone mass: As one gets older, they begin losing minerals from the bones, leading to osteoporosis. It starts as one’s body produces less estrogen.
Increase in body fat and decrease in lean muscle mass: This is because of hormonal changes within one’s body. Men will notice a drop in testosterone levels while women experience a drop in estrogen levels, which causes them to gain more weight, especially around the midsection.

Mimi is aging. There’s no way around that truth. She doesn’t look the way she did in her 20s or even in her 30s. Her hair is turning gray, and she’s gained some weight.

Like Mimi, many people in middle adulthood show visible signs of aging. Gray hair or hair loss become more pronounced in middle age, as do wrinkles and age spots. All of these combine to make middle-aged people look older than they did just a decade before.

It’s not just looks, either. Many people, like Mimi, struggle with hearing and vision loss during middle adulthood. Vision issues first occur usually in dim lighting, like romantic restaurants. Mimi and her husband, for example, like to go out on dates. But Mimi sometimes has a hard time reading the menu in the dim light of the restaurant.

One of the other vision problems common in middle age is presbyopia, which occurs when the lens of the eye loses the ability to adjust to objects at varying distances. This means that people, like Mimi, might struggle to read small print. And like Mimi, many people in middle adulthood end up with reading glasses to help with the problem.

Hearing, too, can be an issue in middle adulthood, especially for higher-pitched sounds. In crowded places with lots of background noise, people like Mimi might discover that they have a hard time distinguishing sounds from one another, which makes conversation difficult.

Physical Mobility in Middle Adulthood
The importance of not succumbing to the temptations of a sedentary lifestyle was as obvious to Hippocrates in 400 BCE as it is now. Piasecki. are of the opinion that sarcopenia (loss of muscle tissue and function as we age) in legs might be the result of leg muscles becoming detached from the nervous system. Further, Piasescki believe that exercise encourages new nerve growth, slowing sarcopenia’s progression. People aged 75 may have up to 30-60% fewer nerve endings in their leg muscles than in their early 20s.

Sarcopenia has only recently been recognized as an independent disease entity since 2016. In 2018 the U.S. Center for Disease Control and prevention assigned sarcopenia its own discrete medical code. Disease entities that affect mobility will become an increasingly costly phenomenon and affect millions of people’s quality of life as the population ages. In many ways, it is a natural phenomenon, and many doctors and researchers have been reticent to overly pathologize natural changes associated with age. However, mobility is now becoming a central concern, and some researchers are now identifying some conditions like osteosarcopenia, which describes the decline of both muscle tissue (sarcopenia) and bone tissue (osteoporosis). Diagnoses and pharmaceuticals which deal with the central question of mobility will become ever more important, even more so as the burgeoning costs associated with caring for those with mobility issues become apparent.

Human beings reach peak bone mass around 35-40. Osteoporosis is a “silent disease” which progresses until a fracture occurs. The sheer scale and cost of this illness is radically underestimated. It is often associated with women due to the fact that bone mass can deteriorate in women much more quickly in middle age due to menopause. After menopause women can lose 5-10% bone mass per year, rendering it advisable to monitor intakes of calcium and Vitamin D, and evaluate individual risk factors. Beginning in their 60s, though, men and women lose bone mass at roughly the same rate. The number of American men diagnosed with osteoporosis is currently around the 2 million mark, with a further 12 million reckoned to be at risk. The National Osteoporosis Foundation (NOF) estimates that 50% of women and 25% of men over the age of 50 will suffer a bone fracture due to osteoporosis. Attention at this stage of life may bring pronounced health benefits now and later for both women and men. Fixing the damage takes a considerable amount of the Medicare budget.

The health benefits that walking and other physical activity have on the nervous system are becoming increasingly obvious to those who study aging. Adami (2018) found pronounced links between weight-bearing exercise and neuron production. We tend to think of the brain as a central processing unit giving instructions to the body via the conduit of the central nervous system, but contemporary science is now coalescing around the idea that muscles and nerves also communicate with the brain—it is a two-way informational and sustaining process. Many studies suggest that voluntary physical activity (VPA) extends and improves the quality of life. Such studies show that even moderate physical activity can bring large gains.

In addition, there is often an increase in chronic inflammation at this time of life with no discernible discrete cause (as opposed to acute inflammation associated with something like an infection). Inflammation is the body’s natural way of responding to bodily injury or harmful pathogens. The function of inflammation is to eliminate the initial cause of injury and initiate tissue repair, but when this happens consistently and for longer periods of time, the body’s stress response systems become overworked. This can have serious effects on health, such as fatigue, fever, chest or abdominal pain, rashes, or greater susceptibility to diseases such as cancer, rheumatoid arthritis, and heart disease. Untreated acute inflammation, autoimmune disorders, or long-term exposure to irritants contribute to social isolation.

Chronic inflammation has been implicated as part of the cause of the muscle loss that occurs with aging. Chronic inflammatory disorder is now implicated in a whole series of chronic diseases such as dementia, and the biomedical evidence for its centrality is now emerging in the medical research literature.

Many of the changes that occur in midlife can be easily compensated for (by buying glasses, exercising, and watching what one eats, for example.) Most midlife adults generally experience good health. However, the percentage of adults who have a disability increases through midlife; while 7 percent of people in their early 40s have a disability, the rate jumps to 30 percent by the early 60s. This increase is highest among those of lower socioeconomic status.

What can we conclude from this information? Again, lifestyle strongly impacts the health status of midlife adults. Smoking tobacco, drinking alcohol, poor diet, stress, physical inactivity, and chronic diseases such as diabetes or arthritis reduce overall health. It becomes important for midlife adults to take preventative measures to enhance physical well-being. Those midlife adults with a strong sense of mastery and control over their lives, who engage in challenging physical and mental activity, who engage in weight-bearing exercise, monitor their nutrition, and use social resources are most likely to enjoy a plateau of good health through these years. Not only that, but those who begin an exercise regimen in their 40s may enjoy comparable benefits to those who began in their 20s according to Saint-Maurice (2019), who also found that while it is never too late to begin, continuing to do as much as possible, is just as important.

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, but a well-rounded program that is easy to follow includes walking and weight training. Having a safe, enjoyable place to walk can make a 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, and learning relaxation techniques can have healthful benefits. Exercise can be considered preventative health care; promoting exercise for the 78 million “baby boomers” may be one of the best ways to reduce health care costs and improve quality of life.

Aging brings about a reduction in the number of calories a person requires. Many Americans respond to weight gain by dieting. However, eating less does not necessarily mean eating right; people often suffer vitamin and mineral deficiencies. Very often, physicians will recommend vitamin supplements to their middle-aged patients. As stated above, chronic inflammation is now identified as one of the so-called “pillars of aging”. The link between diet and inflammation is yet unclear. Still, there is now some information available on the Diet Inflammation Index, which in popular parlance, supports a diet rich in plant-based foods, healthy fats, nuts, fish in moderation, and sparing use of red meat— often referred to as “the Mediterranean Diet.”

The Climacteric
One biologically based change that occurs during midlife is the climacteric. During midlife, men may experience a reduction in their ability to reproduce. Women, however, lose their ability to reproduce once they reach menopause.

Menopause
Menopause refers to a period of transition in which a woman’s ovaries stop releasing eggs and the level of estrogen and progesterone production decreases. After menopause, a woman’s menstruation ceases.

Figure 1. Most women experience some of these common symptoms of menopause, but the severity and experience of these symptoms is also influenced by cultural expectations.

Changes typically occur between the mid-40s and mid-50s. The median age range for a woman to have her last menstrual period is 50-52, but ages vary. A woman may first begin to notice that her periods are more or less frequent than before. These changes in menstruation may last from 1 to 3 years. After a year without menstruation, a woman is considered menopausal and no longer capable of reproduction. (Keep in mind that some women may experience another period even after going for a year without one.) The loss of estrogen also affects vaginal lubrication which diminishes and becomes more watery. The vaginal wall also becomes thinner, and less elastic.

Menopause is not seen as universally distressing. Changes in hormone levels are associated with hot flashes and sweats in some women, but women vary in the extent to which these are experienced. Depression, irritability, and weight gain are not necessarily due to menopause. Depression and mood swings are more common during menopause in women with prior histories of these conditions than those who have not. The incidence of depression and mood swings is not greater among menopausal women than non-menopausal women.

Cultural influences seem to also play a role in the way menopause is experienced. For example, once after listing the symptoms of menopause in a psychology course, a woman from Kenya responded, “We do not have this in my country or if we do, it is not a big deal,” to which some U.S. students replied, “I want to go there!” Indeed, there are cultural variations in the experience of menopausal symptoms. Hot flashes are experienced by 75 percent of women in Western cultures, but by less than 20 percent of women in Japan.

Women in the United States respond differently to menopause depending on their expectations for themselves and their lives. White, career-oriented women, African-American, and Mexican-American women overall tend to think of menopause as a liberating experience. Nevertheless, there has been a popular tendency to erroneously attribute frustrations and irritations expressed by women of menopausal age to menopause and thereby not take her concerns seriously. Fortunately, many practitioners in the United States today are normalizing rather than pathologizing menopause.

Concerns about the effects of hormone replacement have 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. But more recently, hormone replacement therapy has been associated with breast cancer, stroke, and the development of blood clots. Most women do not have symptoms severe enough to warrant estrogen or hormone replacement therapy (HRT). Women who do require HRT can 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 water-based lubricants during intercourse.

Fifty million women in the USA aged 50-55 are post-menopausal. During and after menopause a majority of women will experience weight gain. Changes in estrogen levels lead to a redistribution of body fat from hips and back to stomachs. This is more dangerous to general health and wellbeing because abdominal fat is largely visceral, meaning it is contained within the abdominal cavity and may not look like typical weight gain. That is, it accumulates in the space between the liver, intestines, and other vital organs. This is far more harmful to health than subcutaneous fat, the kind of fat located under the skin. It is possible to be relatively thin and retain a high level of visceral fat, yet this type of fat is deemed especially harmful by medical research.

Andropause
Do males experience a climacteric? Yes. While they do not lose their ability to reproduce as they age, they tend to produce lower testosterone levels and fewer sperm. However, men are capable of reproduction throughout life after puberty. It is natural for sex drive to diminish slightly as men age, but a lack of sex drive may be a result of extremely low levels of testosterone. About 5 million men experience low levels of testosterone that results in symptoms such as a loss of interest in sex, loss of body hair, difficulty achieving or maintaining an erection, loss of muscle mass, and breast enlargement. This decrease in libido and lower testosterone (androgen) levels is known as andropause, although this term is somewhat controversial as this experience is not clearly delineated, as menopause is for women. Low testosterone levels may be due to glandular diseases such as testicular cancer. Testosterone levels can be tested; if they are low, men can be treated with testosterone replacement therapy. This can increase sex drive, muscle mass, and beard growth. However, long term HRT for men can increase the risk of prostate cancer.

The debate around declining testosterone levels in men may hide a fundamental fact. The issue is not about individual males experiencing individual hormonal change at all. We have all seen the adverts on the media promoting substances to boost testosterone: “Is it low-T?” The answer is probably in the affirmative, if somewhat relative. That is, in all likelihood, they will have lower testosterone levels than their fathers. However, it is equally likely that the issue does not lie solely in their individual physiological makeup, but is rather a generational transformation. Why this has occurred in such a dramatic fashion is still unknown. There is evidence that low testosterone may have negative health effects on men. In addition, some studies show evidence of rapidly decreasing sperm count and grip strength. Exactly why these changes are happening is unknown and will likely involve more than one cause.

The Climacteric and Sexuality
Sexuality is an important part of people’s lives at any age. Midlife adults tend to have sex lives that are very similar to that of younger adults. And many women feel freer and less inhibited sexually as they age. However, a woman may notice less vaginal lubrication during arousal and men may experience changes in their erections from time to time. This is particularly true for men after age 65. Men who experience consistent problems are likely to have other medical conditions (such as diabetes or heart disease) that impact sexual functioning.

Couples 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, 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. Seventeen percent of new cases of AIDS in the United States are in people 50 and older. Of all people living with HIV, 47% are aged 50 or over. Practicing safe sex is important at any age- safe sex is not just about avoiding an unwanted pregnancy but also about protecting yourself from STDs. 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 be more able to continue to have satisfying and safe sexual relationships.

What you’ll learn to do: describe cognitive and neurological changes during middle adulthood
A group of people in the workplace gesturing towards a computer screen
While we sometimes associate aging with cognitive decline (often due to how it is portrayed in the media), aging does not necessarily mean a decrease in cognitive function. In fact, tacit knowledge, verbal memory, vocabulary, inductive reasoning, and other types of practical thought skills increase with age. We’ll learn about these advances as well as some neurological changes that happen in middle adulthood in the section that follows.

Cognition in Middle Adulthood
One of the most influential perspectives on cognition during middle adulthood was the Seattle Longitudinal Study (SLS) of adult cognition, which began in 1956. Schaie & Willis summarized the general findings from this series of studies as follows: “We have generally shown that reliably replicable average age decrements in psychometric abilities do not occur before age 60, but that such reliable decrement can be found for all abilities by 74 years of age.” In short, decreases in cognitive abilities begin in the sixth decade and gain increasing significance from that point on. However, Singh-Maoux argue for small but significant cognitive declines beginning as early as age 45. There is some evidence that adults should be as aggressive in maintaining their cognitive health as they are in their physical health during this time as the two are intimately related.

The second source of longitudinal research data on this part of the lifespan has been The Midlife in the United States Studies (MIDUS), which began in 1994. The MIDUS data supports the view that this period of life is something of a trade-off, with some cognitive and physical decreases of varying degrees. The cognitive mechanics of processing speed often referred to as fluid intelligence, physiological lung capacity, and muscle mass, are in relative decline. However, knowledge, experience, and the increased ability to regulate our emotions can compensate for these losses. Continuing cognitive focus and exercise can also reduce the extent and effects of cognitive decline.

Control Beliefs
Central to all of this are personal control beliefs, which have a long history in psychology. Beginning with the work of Julian Rotter, a fundamental distinction is drawn between those who believe that they are the fundamental agent of what happens in their lives and those who believe that they are largely at the mercy of external circumstances. Those who believe that life outcomes are dependent on what they say and do are said to have a strong internal locus of control. Those who believe that they have little control over their life outcomes are said to have an external locus of control.

Empirical research has shown that those with an internal locus of control enjoy better results in psychological tests across the board; behavioral, motivational, and cognitive. It is reported that this belief in control declines with age, but again, there is a great deal of individual variation. This raises another issue: directional causality. Does my belief in my ability to retain my intellectual skills and abilities at this time of life ensure better performance on a cognitive test compared to those who believe in their inexorable decline? Or, does the fact that I enjoy that intellectual competence or facility instill or reinforce that belief in control and controllable outcomes? It is not clear which factor is influencing the other. The exact nature of the connection between control beliefs and cognitive performance remains unclear.

Brain science is developing exponentially and will unquestionably deliver new insights on a whole range of issues related to cognition in midlife. One of them will surely be on the brain’s capacity to renew, or at least replenish itself, at this time of life. The capacity to renew is called neurogenesis; the capacity to replenish what is there is called neuroplasticity. At this stage, it is impossible to ascertain exactly what effect future pharmacological interventions may have on the possible cognitive decline at this, and later, stages of life.

Cognitive Aging
Researchers have identified areas of loss and gain in cognition in older age. Cognitive ability and intelligence are often measured using standardized tests and validated measures. The psychometric approach has identified two categories of intelligence that show different rates of change across the life span. Fluid and crystallized intelligence were first identified by Cattell in 1971. Fluid intelligence refers to information processing abilities, such as logical reasoning, remembering lists, spatial ability, and reaction time. Crystallized intelligence encompasses abilities that draw upon experience and knowledge. Measures of crystallized intelligence include vocabulary tests, solving number problems, and understanding texts. There is a general acceptance that fluid intelligence decreases continually from the 20s, but that crystallized intelligence continues to accumulate. One might expect to complete the NY Times crossword more quickly at 48 than 22, but the capacity to deal with novel information declines.

With age, systematic declines are observed on cognitive tasks requiring self-initiated, effortful processing, without the aid of supportive memory cues. Older adults tend to perform poorer than young adults on memory tasks that involve recall of information, where individuals must retrieve the information they learned previously without the help of a list of possible choices. For example, older adults may have more difficulty recalling facts such as names or contextual details about where or when something happened. What might explain these deficits as we age?

As we age, working memory, or our ability to simultaneously store and use information, becomes less efficient. The ability to process information quickly also decreases with age. This slowing of processing speed may explain age differences in many different cognitive tasks. Some researchers have argued that inhibitory functioning, or the ability to focus on certain information while suppressing attention to less pertinent information, declines with age and may explain age differences in performance on cognitive tasks.

Fewer age differences are observed when memory cues are available, such as for recognition memory tasks, or when individuals can draw upon acquired knowledge or experience. For example, older adults often perform as well if not better than young adults on tests of word knowledge or vocabulary. With age often comes expertise, and research has pointed to areas where aging experts perform as well or better than younger individuals. For example, older typists were found to compensate for age-related declines in speed by looking farther ahead at the printed text. Compared to younger players, older chess experts are able to focus on a smaller set of possible moves, leading to greater cognitive efficiency. Accrued knowledge of everyday tasks, such as grocery prices, can help older adults to make better decisions than young adults.

We began with Schaie and Willis observing that no discernible general cognitive decline could be observed before 60, but other studies contradict this notion. How do we explain this contradiction? In a thought-provoking article, Ramscar argued that an emphasis on information processing speed ignored the effect of the process of learning/experience itself; that is, that such tests ignore the fact that more information to process leads to slower processing in both computers and humans. We are more complex cognitive systems at 55 than 25.

Performance in Middle Adulthood
Research on interpersonal problem solving suggests that older adults use more effective strategies than younger adults to navigate through social and emotional problems. In the context of work, researchers rarely find that older individuals perform less well on the job. Similar to everyday problem solving, older workers may develop more efficient strategies and rely on expertise to compensate for cognitive decline.

Empirical studies of cognitive aging are often difficult, and quite technical, given their nature. Similarly, experiments focused on one task may tell you very little about general capacities. Memory and attention as psychological constructs are now divided into very specific subsets which can be confusing and difficult to compare.

However, one study does show with relative clarity the issues involved. In the USA, The Federal Aviation Authority insists that all air traffic controllers retire at 56 and that they cannot begin until age 31 unless they have previous military experience. However, in Canada controllers are allowed to work until aged 65 and are allowed to train at a much earlier age. Nunes and Kramer studied four groups: a younger group of controllers (20-27), an older group of controllers aged 53 to 64, and two other groups of the same age who were not air traffic controllers. On simple cognitive tasks, not related to their occupational lives as controllers, older controllers were slower than their younger peers. However, when it came to job-related tasks their results were largely identical. This was not true of the older group of non-controllers who had significant deficits in comparison. Specific knowledge or expertise in a domain acquired over time (crystallized intelligence), can offset a decline in fluid intelligence.

Tacit Knowlege
The idea of tacit knowledge was first introduced by Michael Polanyi. He argued that each individual had a huge store of knowledge based on life experience but that it was often difficult to describe, codify, and thus transfer, as stated in his famous formulation, “we always know more than we can tell.” Organizational theorists have spent a great deal of time thinking about the problem of tacit knowledge in this setting. Think of someone you have encountered who is extremely good at their work. They may have no more (or less) education, formal training, and even experience, than others who are supposedly at an equivalent level. What is the “something” that they have? Tacit knowledge is highly prized and older workers often have the greatest amount, even if they are not conscious of that fact.

What you’ll learn to do: analyze emotional and social development in middle adulthood
Two women sitting on different park benches are smiling at each other
Traditionally, middle adulthood has been regarded as a period of reflection and change. In the popular imagination (and academic press) there has been a reference to a “mid-life crisis.” There is an emerging view that this may have been an overstatement—certainly, the evidence on which it is based has been seriously questioned. However, there is some support for the view that people undertake an emotional audit, reevaluate their priorities, and emerge with a slightly different orientation to emotional regulation and personal interaction in this period. Why and the mechanisms through which this change is affected are a matter of debate. We will examine the ideas of Erikson, Baltes, and Carstensen, and how they might inform a more nuanced understanding of this vital part of the lifespan.

What do you think is the happiest stage of life? What about the saddest stages? Perhaps surprisingly, Blanchflower & Oswald found that reported levels of unhappiness and depressive symptoms peak in the early 50s for men in the U.S., and interestingly, the late 30s for women. In Western Europe, minimum happiness is reported around the mid-40s for both men and women, albeit with some significant national differences. Stone, reported a precipitous drop in perceived stress in men in the U.S. from their early 50s. There is now a view that “older people” (50+) may be “happier” than younger people, despite some cognitive and functional losses. This is often referred to as “the paradox of aging.” Positive attitudes to the continuance of cognitive and behavioral activities, interpersonal engagement, and their vitalizing effect on human neural plasticity may lead to more life and to an extended period of self-satisfaction and continued communal engagement.

Erikson’s Theory
Generativity vs. Stagnation (Care)—When people reach their 40s, they enter the time known as middle adulthood, which extends to the mid-60s. The social task of middle adulthood is generativity vs. stagnation the fundamental conflict of adulthood. Generativity involves finding your life’s work and contributing to the development of others through activities such as volunteering, mentoring, and raising children. During this stage, middle-aged adults begin contributing to the next generation, often through caring for others; they also engage in meaningful and productive work that contributes positively to society.

As you know by now, Erikson’s theory is based on an idea called epigenesis,

meaning that development is progressive and that each individual must pass through the eight different stages of life—all while being influenced by context and environment. Each stage forms the basis for the following stage, and each transition to the next is marked by a crisis that must be resolved. The sense of self, each “season”, was wrested, from and by, that conflict. The ages of 40-65 are no different. The individual is still driven to engage productively, but the nurturing of children and income generation assume lesser functional importance. From where will the individual derive their sense of self and self-worth?

Generativity is “primarily the concern in establishing and guiding the next generation” Erikson. Generativity is a concern for a generalized other (as well as those close to an individual) and occurs when a person can shift their energy to care for and mentor the next generation. One obvious motive for this generative thinking might be parenthood, but others have suggested intimations of mortality by the self. Kotre theorized that generativity is a selfish act, stating that its fundamental task was to outlive the self. He viewed generativity as a form of investment. However, a commitment to a “belief in the species” can be taken in numerous directions, and it is probably correct to say that most modern treatments of generativity treat it as a collection of facets or aspects— encompassing creativity, productivity, commitment, interpersonal care, and so on.

On the other side of generativity is stagnation. It is the lethargy, lack of enthusiasm, and involvement in individual and communal affairs. It may also denote an underdeveloped sense of self or some form of overblown narcissism. Erikson sometimes used the word “rejectivity” when referring to severe stagnation. Those who do not master this task may experience stagnation and feel as though they are not leaving a mark on the world in a meaningful way; they may have little connection with others and little interest in productivity and self-improvement.

The Stage-Crisis View and the Midlife Crisis
In 1977, Daniel Levinson published an extremely influential article that would be seminal in establishing the idea of a profound crisis that lies at the heart of middle adulthood. The concept of a midlife crisis is so pervasive that over 90% of Americans are familiar with the term, although those who actually report experiencing such a crisis is significantly lower.

Levinson based his findings of a midlife crisis on biographical interviews with a limited sample of 40 men (no women!), and an entirely American sample at that. Despite these severe methodological limitations, his findings proved immensely influential. Levinson identified five main stages or “seasons” of a man’s life as follows:

1. Preadulthood: Ages 0-22 (with 17 – 22 being the Early Adult Transition years)
2. Early Adulthood: Ages 17-45 (with 40 – 45 being the Midlife Transition years)
3. Middle Adulthood: Ages 40-65 (with 60-65 being the Late Adult Transition years)
4. Late Adulthood: Ages 60-85
5. Late Late Adulthood: Ages 85+

Levinson’s theory is known as the stage-crisis view. He argued that each stage overlaps, consisting of two distinct phases—a stable phase, and a transitional phase into the following period. The latter phase can involve questioning and change, and Levinson believed that 40-45 was a period of profound change, which could only culminate in a reappraisal, or perhaps reaffirmation, of goals, commitments and previous choices—a time for taking stock and recalibrating what was important in life. Crucially, Levinson would argue that a much wider range of factors, primarily work and family, would affect this taking stock – what he had achieved, what he had not; what he thought important, but had brought only limited satisfaction.

In 1996, two years after his death, the study he was conducting with his co-author and wife Judy Levinson, was published on “the seasons of life” as experienced by women. Again, it was a small scale study, with 45 women who were professionals/businesswomen, academics, and homemakers, in equal proportion. The changing place of women in society was reckoned by Levinson to be a profound moment in the social evolution of the human species. However, it had led to a fundamental polarity in the way that women formed and understood their social identity. Levinson referred to this as the “dream.” For men, the “dream” was formed in the age period of 22-28, and largely centered on the occupational role and professional ambitions. Levinson understood the female “dream” as fundamentally split between this work-centered orientation, and the desire/imperative of marriage/family; a polarity that heralded both new opportunities, and fundamental angst.

Levinson found that the men and women he interviewed sometimes had difficulty reconciling the “dream” they held about the future with the reality they currently experienced. “What do I really get from and give to my wife, children, friends, work, community, and self?” a man might ask. Tasks of the midlife transition include:

1. ending early adulthood;
2. reassessing life in the present and making modifications if needed; and
3. reconciling “polarities” or contradictions in one’s sense of self.

Perhaps early adulthood ends when a person no longer seeks adult status but feels like a full adult in the eyes of others. This “permission” may lead to different choices in life—choices that are made for self-fulfillment instead of social acceptance. While people in their 20s may emphasize how old they are (to gain respect, to be viewed as experienced), by the time people reach their 40s, they tend to emphasize how young they are (few 40-year-olds cut each other down for being so young: “You’re only 43? I’m 48!!”).

This new perspective on time brings about a new sense of urgency to life. The person becomes focused more on the present than the future or the past. The person grows impatient at being in the “waiting room of life,” postponing doing the things they have always wanted to do. “If it’s ever going to happen, it better happen now.” A previous focus on the future gives way to an emphasis on the present. Neugarten notes that in midlife, people no longer think of their lives in terms of how long they have lived. Rather, life is thought of in terms of how many years are left. If an adult is not satisfied at midlife, there is a new sense of urgency to make changes.

Changes may involve ending a relationship or modifying one’s expectations of a partner. These modifications are easier than changing the self. Midlife is a period of transition in which one holds earlier images of the self while forming new ideas about the self of the future. A greater awareness of aging accompanies feelings of youth, and harm that may have been done previously in relationships haunts new dreams of contributing to the well-being of others. These polarities are the quieter struggles that continue after outward signs of “crisis” have gone away.

Levinson characterized midlife as a time of developmental crisis. However, like any body of work, it has been subject to criticism. Firstly, the sample size of the populations on which he based his primary findings is too small. By what right do we generalize findings from interviews with 40 men and 45 women, however thoughtful and well-conducted? Secondly, Chiriboga could not find any substantial evidence of a midlife crisis, and it might be argued that this and further failed replication attempts indicate a cohort effect. The findings from Levinson’s population indicated a shared historical and cultural situatedness rather than a cross-cultural universal experienced by all or even most individuals. Midlife is a time of revaluation and change, that may escape precise determination in both time and geographical space, but people do emerge from it, and seem to enjoy a period of contentment, reconciliation, and acceptance of self.

Socio-Emotional Selectivity Theory (SST)
It is the inescapable fate of human beings to know that their lives are limited. As people move through life, goals, and values tend to shift. What we consider priorities, goals, and aspirations are subject to renegotiation. Attachments to others, current, and future, are no different. Time is not the unlimited good as perceived by a child under normal social circumstances; it is very much a valuable commodity, requiring careful consideration in terms of the investment of resources. This has become known in academic literature as mortality salience.

Mortality salience posits that reminders about death or finitude (at either a conscious or subconscious level), fills us with dread. We seek to deny its reality, but awareness of the increasing nearness of death can have a potent effect on human judgment and behavior. This has become a very important concept in contemporary social science. It is with this understanding that Laura Carstensen developed the theory of socioemotional selectivity theory or SST. The theory maintains that as time horizons shrink, as they typically do with age, people become increasingly selective, investing greater resources in emotionally meaningful goals and activities. According to the theory, motivational shifts also influence cognitive processing. Aging is associated with a relative preference for positive over negative information. This selective narrowing of social interaction maximizes positive emotional experiences and minimizes emotional risks as individuals become older. They systematically hone their social networks so that available social partners satisfy their emotional needs. The French philosopher Sartre observed that “hell is other people”. An adaptive way of maintaining a positive effect might be to reduce contact with those we know may negatively affect us, and avoid those who might.

SST is a theory that emphasizes a time perspective rather than chronological age. When people perceive their future as open-ended, they tend to focus on future-oriented development or knowledge-related goals. When they feel that time is running out, and the opportunity to reap rewards from future-oriented goals’ realization is dwindling, their focus tends to shift towards present-oriented and emotion or pleasure-related goals. Research on this theory often compares age groups (e.g., young adulthood vs. old adulthood), but the shift in goal priorities is a gradual process that begins in early adulthood. Importantly, the theory contends that the cause of these goal shifts is not age itself, i.e., not the passage of time itself, but rather an age-associated shift in time perspective. The theory also focuses on the types of goals that individuals are motivated to achieve. Knowledge-related goals aim at knowledge acquisition, career planning, the development of new social relationships, and other endeavors that will pay off in the future. Emotion-related goals are aimed at emotion regulation, the pursuit of emotionally gratifying interactions with social partners, and other pursuits whose benefits can be realized in the present.

This shift in emphasis, from long term goals to short term emotional satisfaction, may help explain the previously noted “paradox of aging.” That is, that despite noticeable physiological declines, and some notable self-reports of reduced life-satisfaction around this time, post- 50 there seems to be a significant increase in reported subjective well-being. SST does not champion social isolation, which is harmful to human health, but shows that increased selectivity in human relationships, rather than abstinence, leads to more positive affect. Perhaps “midlife crisis and recovery” may be a more apt description of the 40-65 period of the lifespan.

Personality in Midlife
Research on adult personality examines normative age-related increases and decreases in the expression of the so-called “Big Five” traits. The Big Five domains include extraversion (attributes such as assertive, confident, independent, outgoing, and sociable), agreeableness (attributes such as cooperative, kind, modest, and trusting), conscientiousness (attributes such as hard-working, dutiful, self-controlled, and goal-oriented), neuroticism (attributes such as anxious, tense, moody, and easily angered), and openness (attributes such as artistic, curious, inventive, and open-minded). The Big Five is one of the most common ways of organizing the vast range of personality attributes that seem to distinguish one person from the next. This organizing framework made it possible for Roberts (2006) to draw broad conclusions from the literature.

These are assumed to be based largely on biological heredity. These five traits are sometimes summarized via the OCEAN acronym. Individuals are assessed by measuring these traits along a continuum (e.g. high extroversion to low extroversion). They now dominate the field of empirical personality research. Does personality change throughout adulthood? Previously the answer was thought to be no. It was William James who stated in his foundational text, The Principles of Psychology (1890), that “in most of us, by the age of thirty, the character is set like plaster, and will never soften again”. Not surprisingly, this became known as the plaster hypothesis.

Contemporary research shows that, although some people’s personalities are relatively stable over time, others’ are not. Longitudinal studies reveal average changes during adulthood, and individual differences in these patterns over the lifespan may be due to idiosyncratic life events (e.g., divorce, illness). In general, average levels of extraversion (especially the attributes linked to self-confidence and independence), agreeableness, and conscientiousness appear to increase with age whereas neuroticism appears to decrease with age. Openness also declines with age, especially after mid-life. These changes are often viewed as positive trends given that higher levels of agreeableness and conscientiousness and lower levels of neuroticism are associated with seemingly desirable outcomes such as increased relationship stability and quality, greater success at work, better health, a reduced risk of criminality and mental health problems, and even decreased mortality. This pattern of positive average changes in personality attributes is known as the maturity principle of adult personality development. The basic idea is that attributes associated with positive adaptation and attributes associated with the successful fulfillment of adult roles tend to increase during adulthood in terms of their average levels.

Carl Jung believed that our personality actually matures as we get older. A healthy personality is balanced. People suffer tension and anxiety when they fail to express all of their inherent qualities. Jung believed that each of us possesses a “shadow side.” For example, those typically introverted also have an extroverted side that rarely finds expression unless we are relaxed and uninhibited. Each of us has both a masculine and feminine side, but in younger years, we feel societal pressure to give expression only to one. As we get older, we may become freer to express all of our traits as the situation arises. We find gender convergence in older adults. Men become more interested in intimacy and family ties. Women may become more assertive. This gender convergence is also affected by changes in society’s expectations for males and females. With each new generation, we find that the roles of men and women are less stereotypical, which also allows for change.

Subjective Aging
One aspect of the self that particularly interests life span and life course psychologists is the individual’s perception and evaluation of their own aging and identification with an age group. Subjective age is a multidimensional construct that indicates how old (or young) a person feels, and into which age group a person categorizes themself. After early adulthood, most people say they feel younger than their chronological age, and the gap between subjective and actual age generally increases. On average, after age 40 people report feeling 20% younger than their actual age (e.g., Rubin & Berntsen,). Asking people how satisfied they are with their own aging assesses an evaluative component of age identity. Whereas some aspects of age identity are positively valued (e.g., acquiring seniority in a profession or becoming a grandparent), others may be less valued, depending on societal context. Perceived physical age (i.e., the age one looks in a mirror) is one aspect that requires considerable self-related adaptation in social and cultural contexts that value young bodies. Feeling younger and being satisfied with one’s own aging are expressions of positive self-perceptions of aging. They reflect the operation of self-related processes that enhance well-being. Levy found that older individuals who can adapt to and accept changes in their appearance and physical capacity in a positive way report higher well-being, have better health, and live longer.

There is now an increasing acceptance of the view within developmental psychology that an uncritical reliance on chronological age may be inappropriate. People have certain expectations about getting older, their own idiosyncratic views, and internalized societal beliefs. Taken together they constitute a tacit knowledge of the aging process. A negative perception of how we are aging can have real results in terms of life expectancy and poor health. Levy estimated that those with positive feelings about aging lived 7.5 years longer than those who did not. Subjective aging encompasses a wide range of psychological perspectives and empirical research. However, there is now a growing body of work centered around a construct referred to as Awareness of Age-Related Change (AARC), which examines the effects of our subjective perceptions of age and their consequential, and very real, effects. Neuport & Bellingtier report that this subjective awareness can change on a daily basis, and that negative events or comments can disproportionately affect those with the most positive outlook on aging.

Work Satisfaction
Middle adulthood is characterized by a time of transition, change, and renewal. Accordingly, attitudes about work and satisfaction from work tend to undergo a transformation or reorientation during this time. Age is positively related to job satisfaction—the older we get the more we derive satisfaction from work. However, that is far from the entire story and repeats, once more, the paradoxical nature of the research findings from this period of the life course. Dobrow, Gazach & Liu found that job satisfaction in those aged 43-51 was correlated with advancing age, but that there was increased dissatisfaction the longer one stayed in the same job. Again, as socio-emotional selectivity theory would predict, there is a marked reluctance to tolerate a work situation deemed unsuitable or unsatisfying. Years left, as opposed to years spent, necessitates a sense of purpose in all daily activities and interactions, including work.

Some people love their jobs, some people tolerate their jobs, and some people cannot stand their jobs. Job satisfaction describes the degree to which individuals enjoy their job. It was described by Edwin Locke as the state of feeling resulting from appraising one’s job experiences. While job satisfaction results from both how we think about our work (our cognition) and how we feel about our work (our affect), it is described in terms of effect. Job satisfaction is impacted by the work itself, our personality, and the culture we come from and live in.

Job satisfaction is typically measured after a change in an organization, such as a shift in the management model, to assess how the change affects employees. It may also be routinely measured by an organization to assess one of many factors expected to affect the organization’s performance. In addition, polling companies like Gallup regularly measure job satisfaction nationally to gather broad information on the state of the economy and the workforce.

Job satisfaction is measured using questionnaires that employees complete. Sometimes a single question might be asked in a very straightforward way to which employees respond using a rating scale, such as a Likert scale, which was discussed in the chapter on personality. A Likert scale (typically) provides five possible answers to a statement or question that allows respondents to indicate their positive-to-negative strength of agreement or strength of feeling regarding the question or statement. Thus the possible responses to a question such as “How satisfied are you with your job today?” might be “Very satisfied,” “Somewhat satisfied,” “Neither satisfied nor dissatisfied,” “Somewhat dissatisfied,” and “Very dissatisfied.” More commonly the survey will ask a number of questions about the employee’s satisfaction to determine more precisely why he is satisfied or dissatisfied. Sometimes these surveys are created for specific jobs; at other times, they are designed to apply to any job. Job satisfaction can be measured at a global level, meaning how satisfied in general the employee is with work, or at the level of specific factors intended to measure which aspects of the job lead to satisfaction (Table 2).
Table 2
Research has suggested that the work-content factor, which includes variety, difficulty level, and role clarity of the job, is the most strongly predictive factor of overall job satisfaction. In contrast, there is only a weak correlation between pay level and job satisfaction. It is suggested that individuals adjust or adapt to higher pay levels: Higher pay no longer provides the satisfaction the individual may have initially felt when her salary increased.

Why should we care about job satisfaction? Or more specifically, why should an employer care about job satisfaction? Measures of job satisfaction are somewhat correlated with job performance; in particular, they appear to relate to organizational citizenship or discretionary behaviors on the part of an employee that further the goals of the organization. Job satisfaction is related to general life satisfaction, although there has been limited research on how the two influence each other or whether personality and cultural factors affect both job and general life satisfaction. One carefully controlled study suggested that the relationship is reciprocal: Job satisfaction affects life satisfaction positively, and vice versa. Of course, organizations cannot control life satisfaction’s influence on job satisfaction. Job satisfaction, specifically low job satisfaction, is also related to withdrawal behaviors, such as leaving a job or absenteeism. The relationship with turnover itself, however, is weak. Finally, it appears that job satisfaction is related to organizational performance, which suggests that implementing organizational changes to improve employee job satisfaction will improve organizational performance.

There is an opportunity for more research in the area of job satisfaction. For example, Weiss (2002) suggests that the concept of job satisfaction measurements have combined both emotional and cognitive concepts, and measurements would be more reliable and show better relationships with outcomes like performance if the measurement of job satisfaction separated these two possible elements of job satisfaction.

The workplace today is one in which many people from various walks of life come together. Work schedules are more flexible and varied, and more work independently from home or anywhere there is an internet connection. The midlife worker must be flexible, stay current with technology, and be capable of working within a global community.

Work-Family Balance
Many people juggle the demands of work-life with the demands of their home life, whether it be caring for children or taking care of an elderly parent; this is known as work-family balance. We might commonly think about work interfering with family, but it is also the case that family responsibilities may conflict with work obligations. Greenhaus and Beutell first identified three sources of work-family conflicts:
-time devoted to work makes it difficult to fulfill requirements of family or vice versa,
-strain from participation in work makes it difficult to fulfill requirements of family or vice versa, and
-specific behaviors required by work make it difficult to fulfill the requirements of family or vice versa.
Women often have greater responsibility for family demands, including home care, child care, and caring for aging parents, yet men in the United States are increasingly assuming a greater share of domestic responsibilities. However, research has documented that women report greater levels of stress from work-family conflict.

There are many ways to decrease work-family conflict and improve people’s job satisfaction. These include support in the home, which can take various forms: emotional (listening), practical (help with chores). Workplace support can include understanding supervisors, flextime, leave with pay, and telecommuting. Flextime usually requires core hours spent in the workplace around which the employee may schedule his arrival and departure to meet family demands. Telecommuting involves employees working at home and setting their own hours, which allows them to work during different parts of the day, and to spend part of the day with their family; this may also be known as e-commuting, working remotely, flexible workspace, or simply working from home. Recall that Yahoo! had a policy of allowing employees to telecommute and then rescinded the policy. Some organizations have onsite daycare centers, and some companies even have onsite fitness centers and health clinics. In a study of the effectiveness of different coping methods, Lapierre & Allen found practical support from home more important than emotional support. They also found that immediate-supervisor support for a worker significantly reduced work-family conflict through such mechanisms as allowing an employee the flexibility needed to fulfill family obligations. In contrast, flextime did not help with coping and telecommuting actually made things worse, perhaps reflecting the fact that being at home intensifies the conflict between work and family because, with the employee in the home, the demands of family are more evident.

Posig & Kickul identify exemplar corporations with policies that reduce work-family conflict. Examples include IBM’s policy of three years of job-guaranteed leave after the birth of a child, Lucent Technologies offer of one year’s childbirth leave at half-pay and SC Johnson’s program of concierge services for daytime errands.

Relationships at Work
Working adults spend a large part of their waking hours in relationships with coworkers and supervisors. Because these relationships are forced upon us by work, researchers focus less on their presence or absence and instead focus on their quality. High quality work relationships can make jobs enjoyable and less stressful. This is because workers experience mutual trust and support in the workplace to overcome work challenges. Liking the people we work with can also translate to more humor and fun on the job. Research has shown that more supportive supervisors have employees who are more likely to thrive at work. On the other hand, poor quality work relationships can make a job feel like a drudgery. Everyone knows that horrible bosses can make the workday unpleasant. Supervisors that are sources of stress negatively impact their employees’ subjective well-being. Specifically, research has shown that employees who rate their supervisors high on the so-called “dark triad”—psychopathy, narcissism, and Machiavellianism—reported greater psychological distress at work and less job satisfaction.

In addition to the direct benefits or costs of work relationships on our well-being, we should also consider how these relationships can impact our job performance. Research has shown that feeling engaged in our work and having a high job performance predicts better health and greater life satisfaction. Given that so many of our waking hours are spent on the job—about 90,000 hours across a lifetime—it makes sense that we should seek out and invest in positive relationships at work.

One of the most influential researchers in this field, Dorien Kooij identified four key motivations in older adults continuing to work. First, growth or development motivation- looking for new challenges in the work environment. The second are feelings of recognition and power. Third, feelings of power and security afforded by income and possible health benefits. Interestingly enough, the fourth area of motivation was Erikson’s generativity. The latter has been criticized for a lack of support in terms of empirical research findings, but two studies found that a primary motivation in continuing to work was the desire to pass on skills and experience, a process they describe as leader generativity. Perhaps a more straightforward term might be mentoring. In any case, the generative leadership concept is firmly established in the business and organizational management literature.

Organizations, public and private, are going to have to deal with an older workforce. The proportion of people in Europe over 60 will increase from 24% to 34% by 2050, the US Bureau of Labor Statistics predicts that 1 in 4 of the US workforce will be 55 or over. Workers may have good reason to avoid retirement, although it is often viewed as a time of relaxation and well-earned rest, statistics may indicate that a continued focus on the future may be preferable to stasis, or inactivity. In fact, Fitzpatrick & Moore report that death rates for American males jump 2% immediately after they turn 62, most likely a result of changes induced by retirement. Interestingly, this small spike in death rates is not seen in women, which may be the result of women having stronger social determinants of health (SDOH), which keep them active and interacting with others out of retirement.

The importance of establishing and maintaining relationships in middle adulthood is now well established in the academic literature—there are now thousands of published articles purporting to demonstrate that social relationships are integral to any and all aspects of subjective well-being and physiological functioning, and these help to inform actual healthcare practices. Studies show an increased risk of dementia, cognitive decline, susceptibility to vascular disease, and increased mortality in those who feel isolated and alone. However, loneliness is not confined to people living a solitary existence. It can also refer to those who endure a perceived discrepancy in the socio-emotional benefits of interactions with others, either in number or nature. One may have an expansive social network and still feel a dearth of emotional satisfaction in one’s own life.

Socioemotional selectivity theory (SST) predicts a quantitative decrease in the number of social interactions in favor of those bringing greater emotional fulfillment. Over the past thirty years, or more, significant social changes have, in turn, had a large effect on human bonding. These have affected the way we manage our emotional interactions, and the manner in which society views, shapes and supports that emotional regulation. Government policy has also changed and profoundly influenced how families are shaped, reshaped, and operate as social and economic agents.

Relationships and Family Life in Middle Adulthood
Types of Relationships
Intimate Relationships
It makes sense to consider the various types of relationships in our lives when determining how relationships impact our well-being. For example, would you expect a person to derive the same happiness from an ex-spouse as from a child or coworker? Among the most important relationships for most people is their long-time romantic partner. Most researchers begin their investigation of this topic by focusing on intimate relationships because they are the closest form of a social bond. Intimacy is more than just physical in nature; it also entails psychological closeness. Research findings suggest that having a single confidante—a person with whom you can be authentic and trust not to exploit your secrets and vulnerabilities—is more important to happiness than having a large social
network.

Another important aspect of relationships is the distinction between formal and informal. Formal relationships are those that are bound by the rules of politeness. In most cultures, for instance, young people treat older people with formal respect, avoiding profanity and slang when interacting with them. Similarly, workplace relationships tend to be more formal, as do relationships with new acquaintances. Formal connections are generally less relaxed because they require a bit more work, demanding that we exert more self-control. Contrast these connections with informal relationships—friends, lovers, siblings, or others with whom you can relax. We can express our true feelings and opinions in these informal relationships, using the language that comes most naturally to us, and generally, be more authentic. Because of this, it makes sense that more intimate relationships—those that are more comfortable and in which you can be more vulnerable—might be the most likely to translate to happiness.

Marriage and Happiness
One of the most common ways that researchers often begin to investigate intimacy is by looking at marital status. The well-being of married people is compared to that of people who are single or have never been married. In other research, married people are compared to people who are divorced or widowed. Researchers have found that the transition from singlehood to marriage increases subjective well-being. In fact, this finding is one of the strongest in social science research on personal relationships over the past quarter of a century.

As is usually the case, the situation is more complex than might initially appear. As a marriage progresses, there is some evidence for a regression to a hedonic set-point—that is, most individuals have a set happiness point or level, and that both good and bad life events – marriage, bereavement, unemployment, births, and so on – have some effect for a period of time, but over many months, they will return to that set-point. One of the best studies in this area is that of Luhmann (2012), who report a gradual decline in subjective well-being after a few years, especially in the component of affective well-being. Adverse events obviously have an effect on subjective well-being and happiness, and these effects can be stronger than the positive effects of being married in some cases.

Although research frequently points to marriage being associated with higher rates of happiness, this does not guarantee that getting married will make you happy! The quality of one’s marriage matters greatly. It takes an emotional toll when a person remains in a problematic marriage. Indeed, a large body of research shows that people’s overall life satisfaction is affected by their satisfaction with their marriage. The lower a person’s self-reported level of marital quality, the more likely he or she is to report depression. In fact, longitudinal studies—those that follow the same people over a period of time—show that as marital quality declines, depressive symptoms increase. Proulx and colleagues reached this conclusion after a systematic review of 66 cross-sectional and 27 longitudinal studies.

Marital satisfaction has peaks and valleys during the course of the life cycle. Rates of happiness are highest in the years prior to the birth of the first child. It hits a low point with the coming of children. Relationships typically become more traditional, and living has more financial hardships and stress. Children bring new expectations to the marital relationship. Two people who are comfortable with their roles as partners may find the added parental duties and expectations more challenging to meet. Some couples elect not to have children in order to have more time and resources for the marriage. These child-free couples are happy keeping their time and attention on their partners, careers, and interests.

What is it about bad marriages or bad relationships in general, that takes such a toll on well-being? Research has pointed to the conflict between partners as a major factor leading to lower subjective well-being. This makes sense. Negative relationships are linked to ineffective social support and are a source of stress. In more extreme cases, physical and psychological abuse can harm well-being. Victims of abuse sometimes feel shame, lose their sense of self, and become less happy and prone to depression and anxiety. However, the unhappiness and dissatisfaction that occur in abusive relationships tend to dissipate once the relationships end.

Typology of Marriage
One way marriages vary is with regard to the reason the partners are married. Some marriages have intrinsic value: the partners are together because they enjoy, love, and value one another. Marriage is not considered a means to another end; instead, it is regarded as an end. These partners look for someone they are drawn to, and with whom they feel a close and intense relationship. Other marriages called utilitarian marriages, are unions entered into primarily for practical reasons. For example, the marriage brings financial security, children, social approval, housekeeping, political favor, a good car, a great house, and so on.

There have been a few attempts to establish a typological framework for marriages. The best-known is that of Olson, who referred to five typical kinds of marriage. Using a sample of 6,267 couples, Olson & Fowers identified eleven relationship domains which covered both areas related to relationship satisfaction and the more functional areas related to marriage. So, five of the eleven included areas such as marital satisfaction, communication, and, things like financial management, parenting, and egalitarian roles. Using these eleven areas they came up with five kinds of marriage. One aspect of this early study is the link between marital satisfaction and income/college education. The link between these factors is now commonplace in the literature. Olson & Fowers were one of the first studies to point to this link. The less well-off are more prone to divorce than those with less college-level education. Income and college education are linked, and there is increasing concern that marital dissolution and broader social inequality patterns are inextricably linked.

-vitalized: Very high relationship quality. Tend to belong in a higher income bracket. Happy with their spouse across all areas: personality, communication, roles, and expectations.

-harmonious relationships: These marriages have some areas of tension and disagreement but there is still broad agreement on major issues. Lack of agreement on parenting was the primary feature of this group, although the couples still scored highly on relationship quality.

-traditional marriages: Much less emphasis on emotional closeness, but still slightly above average. High levels of compatibility in relation to parenting.

-conflicted: These marriages accomplish functional goals such as parenting but are marked by a great deal of interpersonal disagreement. Communication and conflict resolution scores are extremely low.
-devitalized: low scores across all eleven areas – Little interpersonal closeness and little agreement on family roles.

Marital Communication
Advice on how to improve one’s marriage is centuries old. One of today’s experts on marital communication is John Gottman. Gottman differs from many marriage counselors in his belief that having a good marriage does not depend on compatibility, rather, the way that partners communicate with one another is crucial. At the University of Washington in Seattle, Gottman has measured the physiological responses of thousands of couples as they discuss issues that have led to disagreements. Fidgeting in one’s chair, leaning closer to or further away from the partner while speaking, and increases in respiration and heart rate are all recorded and analyzed, along with videotaped recordings of the partners’ exchanges.

Gottman believes he can accurately predict whether or not a couple will stay together by analyzing their communication. In marriages destined to fail, partners engage in the “marriage killers” such as contempt, criticism, defensiveness, and stonewalling. Each of these undermines the politeness and respect that healthy marriages require. According to Gottman, stonewalling, or shutting someone out, is the strongest sign that a relationship is destined to fail. Perhaps the most interesting aspect of Gottman’s work is the emphasis on the fact that marriage is about constant negotiation rather than conflict resolution.

What Gottman terms perpetual problems, are responsible for 69% of conflicts within marriage. For example, if someone in a couple has said, “I am so sick of arguing over this,” then that may signify a perpetual problem. While this may seem problematic, Gottman argues that couples can still be connected despite these perpetual problems if they can laugh about it, treat it as a “third thing” (not reducible to the perspective of either party), and recognize that these are part of relationships that need to be aired and dealt with as best you can. It is somewhat refreshing to hear that differences lie at the heart of marriage, rather than a rationale for its dissolution!

Parenting in Later Life
Just because children grow up does not mean their family stops being a family, rather the specific roles and expectations of its members change over time. One major change comes when a child reaches adulthood and moves away. When exactly children leave home varies greatly depending on societal norms and expectations and economic conditions such as employment opportunities and affordable housing options. Some parents may experience sadness when their adult children leave the home—a situation called an empty nest.

Many parents also find that their grown children are struggling to become independent. It’s an increasingly common story: a child goes off to college and, upon graduation, cannot find steady employment. In such instances, a frequent outcome is for the child to return home, becoming a “boomerang kid.” The boomerang generation, as the phenomenon has come to be known, refers to young adults, mostly between the ages of 25 and 34, who return home to live with their parents while they strive for stability in their lives—often in terms of finances, living arrangements, and sometimes romantic relationships. These boomerang kids can be both good and bad for families. Within American families, 48% of boomerang kids report paying their parents rent, and 89% say they help out with household expenses—a win for everyone. On the other hand, 24% of boomerang kids report that returning home hurts their relationship with their parents. For better or worse, the number of children returning home has been increasing worldwide. The Pew Research Center reported that the most common living arrangement for people aged 18-34 was living with their parents (32.1%).

Adult children typically maintain frequent contact with their parents, if for no other reason, money, and advice. Attitudes toward one’s parents may become more accepting and forgiving, as parents are seen in a more objective way, as people with good points and bad. As adults children can continue to be subjected to criticism, ridicule, and abuse at the hand of parents. How long are we “adult children”? For as long as our parents are living, we continue in the role of son or daughter. (I had a neighbor in her nineties who would tell me her “boys” were coming to see her this weekend. Her boys were in their 70s-but they were still her boys!) But after one’s parents are gone, the adult is no longer a child; as one 40-year-old man explained after his father’s death, “I’ll never be a kid again.”

Family Issues and Considerations
In addition to middle-aged parents spending more time, money, and energy taking care of their adult children, they are also increasingly taking care of their own aging and ailing parents. In this set of circumstances, middle-aged people are commonly referred to as the sandwich generation. Of course, cultural norms and practices again come into play. In some Asian and Hispanic cultures, the expectation is that adult children are supposed to take care of aging parents and parents-in-law. In other Western cultures—cultures that emphasize individuality and self-sustainability—the expectation has historically been that elders either age in place, modifying their home and receiving services to allow them to continue to live independently or enter long-term care facilities. However, given financial constraints, many families find themselves taking in and caring for their aging parents, increasing the number of multigenerational homes around the world.

Being a midlife child often involves kin keeping; organizing events and communication to maintain family ties. This role was first defined by Carolyn Rosenthal. Kinkeepers are often midlife daughters (they are the person who tells you what food to bring to a gathering, or makes arrangement for a family reunion). They can often function as “managers” who maintain family ties and lines of communication. This is true for both large nuclear families, reconstituted, and multi-generational families. Rosenthal found that over half of the families she sampled could identify the individual who performed this role. Often adults at this stage of their lives are pressed into caregiving roles. Often referred to as the “sandwich generation”, they are still looking out for their own children while simultaneously caring for elderly parents. Given shifts in longevity and increasing costs for professional care of the elderly, this role will likely expand, placing ever greater pressure on careers.

Divorce and Remarriage
Divorce
Divorce refers to the legal dissolution of a marriage. Depending on societal factors, divorce may be more or less of an option for married couples. Despite popular belief, divorce rates in the United States actually declined for many years during the 1980s and 1990s, and only just recently started to climb back up—landing at just below 50% of marriages ending in divorce today; however, it should be noted that divorce rates increase for each subsequent marriage, and there is considerable debate about the exact divorce rate. Are there specific factors that can predict divorce? Are certain types of people or certain types of relationships more or less at risk for breaking up? Indeed, several factors appear to be either risk factors or protective factors.

Pursuing education decreases the risk of divorce. So too does waiting until we are older to marry. Likewise, if our parents are still married, we are less likely to divorce. Factors that increase our risk of divorce include having a child before marriage and living with multiple partners before marriage, known as serial cohabitation (cohabitation with one’s expected marital partner does not appear to have the same effect). Of course, societal and religious attitudes must also be taken into account. Divorce rates tend to be higher in societies that are more accepting of divorce. Likewise, divorce rates tend to be lower in religions that are less accepting of divorce.

If a couple does divorce, there are specific considerations they should consider to help their children cope. Parents should reassure their children that both parents will continue to love them and that the divorce is in no way the children’s fault. Parents should also encourage open communication with their children and be careful not to bias them against their “ex” or use them as a means of hurting their “ex”.

Table 3. Factors of divorce

A “Gray Divorce Revolution”?
In 2013 Brown and Lin referred to a “gray divorce revolution”. The figures certainly seem to support their contention. The rate of divorce had doubled for those aged 50-64 in the twenty years between 1990 and 2010. One in 10 persons who divorced in 1990 was over age 50, by 2010 it was over 1 in 4, accounting for some 25% of all divorces in the USA. Various explanations have been offered for this phenomenon. The “baby boomers” had divorced in large numbers in early adulthood, and many remarriages within this group also ended in divorce. Remarriages are about 2.5 times more likely to end in divorce than first marriages. People live longer and are no longer satisfied with relationships deemed insufficient to meet their emotional needs. The shift to companionate marriage in the latter half of the 20th century had followed this segment of the population into midlife, with divorce rates diminishing or stabilizing for other segments of the population.

Socio-emotional selectivity theory would predict that the shift of perspective from time spent to time remaining would predict people valuing experiences and relationships in the present, rather than holding onto memories of the past, or an idealized vision of what might yet come to be. Nevertheless, Cohen (2018) predicts a substantial decline in divorce rates for those who are not part of the “baby boom” generation and that marriage rates will stabilize once more in subsequent generational cohorts. There has been a marked decline in divorce rates for those under 45 and the link between college education and marriage is now quite pronounced. People are now waiting until later in life to marry for the first time. The average age is now 27 for women and 29 for men, and it is even higher in urban centers like NYC. However, Reeves show that just over half of women with high school diplomas in their 40s are married, with the figures rising to 75% of those women with bachelor’s degrees. Increasing economic insecurity may have played a part in ensuring that marriage is increasingly correlated with educational attainment and socioeconomic status rather than cohorts based solely on age.

U.S. households are now increasingly single-person households. The number is reckoned to be in excess of 28% of all households and may become the most common form in the near future if trends in Europe are anything to go by. There, the number of one-person households in countries and Denmark and Germany exceeds 40%, with other major European countries like France not far from reaching that proportion. The number of Americans who are unmarried continues to increases. About 45% of all Americans over the age of 18 are unmarried, in 1960 that number was 28%. Around 1 in 4 young adults in the USA, today will never marry. The diversity of households will continue to increase. Currently, the number of one-person households in Japan and Germany is double that of households with children under 18.

Remarriage and Repartnering
Middle adulthood seems to be the prime time for remarriage, as the Pew Research Center reported in 2014 that of those aged between 55-64 who had previously been divorced, 67% had remarried. In 1960, it was 55%. Every other age category reported declines in the number of remarriages. Remarriage is more popular with men than women, a gender gap that persists and grows substantially in middle and later adulthood. Cohabitation is the main way couples prepare for remarriage, but many important issues are still not discussed even when living together. Issues concerning money, ex-spouses, children, visitation, future plans, previous difficulties in marriage, etc. can all pose problems later in the relationship. Few couples engage in premarital counseling or other structured efforts to cover this ground before entering into marriage again.

The divorce rate for second marriages is reckoned to be in excess of 60%, and for third marriages even higher. There is little research in the area of repartnering and remarriage, and the choices and decisions made during the process. A notable exception is that of Brown who offer an overview of the little that there is, and their own conclusions. One important constraint which they note is that men prefer younger women, at least as far as remarriage is concerned. Indeed, the gap in age is often more pronounced in second marriages than in the first, according to Pew. Allied to the fact that women live, on average, five years longer in the USA, then the pool of available partners shrinks for women. Brown, also argue that this is further reinforced by the fact that women have a preference for retaining their autonomy and not playing the role of caregiver again. Perhaps the most interesting aspect of their research is the fact that those who repartner tend to do so quickly, and that longer-term singles are more likely to remain so.

Reviews are mixed as to how happy remarriages are. Some say they have found the right partner and learned from their mistakes. But the divorce rates for remarriages are higher than for first marriages. This is especially true in stepfamilies for reasons which we have already discussed. Married people tend to divorce more quickly than in first marriages. This may be because they have fewer constraints on staying married (are more financially or psychologically independent).

Factors Affecting Remarriage
The chances of remarrying depend on a number of things. First, it depends on the availability of partners. As time goes by, there are more available women than men in the marriage pool as noted above. Consequently, men are more likely than women to remarry. This lack of available partners is experienced by all women, but especially by African-American women where the ratio of women to men is quite high. Women are more likely to have children living with them, which diminishes the chance of remarriage. And marriage is more attractive for males than females. Men tend to remarry sooner (3 years after divorce on average vs. 5 years on average for women).

Many women do not remarry because they do not want to remarry. Traditionally, marriage has provided more benefits to men than to women. Women typically have to make more adjustments in work (accommodating work life to meet family demands or the approval of the husband) and at home (taking more responsibility for household duties). Education increases men’s likelihood of remarrying but may reduce the likelihood for women. Part of this is due to the expectation (almost an unspoken rule) referred to as the “marriage gradient.” This rule suggests among couples, the man is supposed to have more education than the woman. Today, there are more women with higher levels of education than before and women with higher levels are less likely to find partners matching this expectation. Being happily single requires being economically self-sufficient and being psychologically independent. Women in this situation may find remarriage much less attractive.

One key factor in understanding some of these issues is the level of continuing parental investment in adult children, and possibly their children. The number of grandparents raising children in the USA is reckoned to be in the vicinity of 2.7 million. In addition, there is the continued support of adult children themselves which can be substantial. The Pew Research document “Helping Adult Children” indicates the nature and extent of this support, which tends to be even greater in Europe than the USA, with 60% of Italian parents reporting an adult child residing with them most of the year.

Blended Families
Most academic research on reconstituted or blended families focuses on younger adults and the difficulties that ensue when trying to blend children raised by a different spouse/partner and one or more adults with perhaps different views or experience on how this might be accomplished. All sorts of issues can arise: conflicted loyalties, different attitudes to discipline, role-ambiguity, and the simple fact of a far-reaching change easily perceived as a disruption on the part of a child. Given the rise of the gray divorce, it is increasingly the case that this age group will encounter later age, or adult children (sometimes called the “boomerang generation”), in the house of their new partners. Such encounters are even more likely given the rise of the so-called “silver surfer” utilizing online dating sites and the fact that an increasing number of adult children continue to live at home given the increased cost of housing.

There has not been substantial research on recoupling and blended families in later life, but Papernow notes that all of the factors normally in play with younger children can be just as present, and even exacerbated, by the fact that previous relationships have had an even longer time to grow and solidify. In addition, stepfamilies formed in later life may have very difficult and complicated decisions to make about estate planning and elder care, as well as navigating daily life together, as an increasing number of young adults live at home (“grown but not gone”). Papernow lists five challenges for later-life stepfamilies:

-Stepparents are stuck as outsiders, while parents are the insiders in their relationships with their families.

-Stepchildren struggle with the change, even as adults, as they navigate new dynamics in family gatherings, status, and loyalty issues

-Parenting and discipline issues polarize the parents and stepparents. In general, stepparents want more discipline and are viewed as harsher, while parents want more understanding and are viewed more as the pushover. There are often disagreements about how much support (financial, physical, and emotional) to give older children.

-Stepfamilies must build a new family culture, even after at least two established family cultures are coming together.

-Ex-spouses are still part of a stepfamily, and children, even adult children, are worse off when involved in the conflict between their parents’ ex-spouses.

At the beginning of this section, we referred to the physical, psychological, and social aspects of middle adulthood. These have ranged from minor physiological changes to the way that knowledge of our own mortality may influence how we behave and feel during this part of the lifespan. The central theme might be identified as connection—the way that the body and mind are connected, how one can affect the other, exemplified by how physical mobility can impact cerebral acuity. In addition, we have learned that we are more selective in regard to the interpersonal connection as we age. The positive aspects of relationships, work, and the family assumes ever greater importance. Hope is ever-present, but these sorts of positive and fulfilling connections cannot be postponed indefinitely. Freud believed civilization was only possible if humans could be induced or trained to defer immediate gratification. That was what the process of primary childhood socialization was about. Perhaps middle adulthood demands that we unlearn this, if only partially. At this stage of the life course, it is now or never. Time is finite and there is none left for indefinite postponement. This is what modern developmental theory has come to understand as mortality salience.

Developmental perspectives have tended to view intimacy and familial relationships as a universal need and function. It has largely left their transformation by divorce, cohabitation, and so forth to the sociologists. However, there is now a clearer understanding of the way that structural economic and social change have impacted family structures, often in those least able to resist the disruptive effects of social inequality. Income and education levels play a large part in this as lifestyle choices and selectivity. We can only hope that advances in medical science can lead to greater quality of life at this stage of life and that they are made widely available.

Frequently Asked Questions
What are the main characteristics of middle adulthood?
Middle adulthood is the period of life that spans from the late 30s to the early 50s. This is a transitional period where people experience a great deal of change, both personally and professionally.

The transition to middle adulthood can be challenging for many people because they go through significant changes in their life, including changing roles or relationships. People experience feelings of regret about what they have left behind or have not done yet.

Why is middle adulthood important?
Middle adulthood is a time of transition and change. It is the period in which people become more independent and reliant on their partners. It is also when people are more likely to be single, divorced, or widowed. Some of the significant events that happened during this period include:

• Marriage or remarriage
• Divorce
• Death of spouse or partner
• Birth of a first child
• Retirement

What happens in the middle adulthood stage?
With a sense of uncertainty and instability that characterizes this stage, middle adulthood is often associated with the idea that one has not found their place in society yet and may have difficulty finding it. Middle adulthood is also known as a midlife crisis because it is a transition period where people struggle to find their place in life.

To wrap up this chapter I want to stipulate that I am in this age range. I will be turning 60 in 2023. While my aspirations and desires are still that of a younger person, my body is starting to betray me. I was recently diagnosed with low testosterone levels, hypertension, morbid obesity and pre-diabetes. To correct some of these problems, I now take testoterone injections monthly, and I had a gastric sleeve procedure done. My energy levels have started to rise. I have lost over 80 pounds and I am no longer pre-diabetic. I am still considered to be obese by the BMI scale, I feel a lot better. I am able to go hiking now without getting out of breath and my work is somewhat easier. My hips and knees seem to hurt less now that I am carrying all that extra weight. I still hope to lose 25 more pounds. If I can do so, I will no longer considered to be obese. I also want to tone up some of that flab. My body has gotten a little soft over the years. If you have a strong core the chances of you experiencing many of the aches and pains that are commonly associated with aging will diminish somewhat.

While I still don’t care that much for tent camping, especially sleeping in small backpacking tents, I am able to get in and out a little easier. Even though I am getting in better shape my recovery times from heavy exertion are much longer than I ever remembered previously. My wife and I just tried a new activity, and that was backpacking and kayaking as one activity. I carried an inflatable kayak in my backpack. The weight of my pack was close to 80 pounds. Thank God the hike was under three miles. But the hike just about killed me. Ten years ago I could have done that hike much easier. I also discovered that the older you get the less likely you are to take risks. I guess somewhere in my brain, I realize that I no longer can do everything that I used to do.

References
study.com, “Middle Adulthood: Physical Development & Examples.”; open.maricopa.edu, “ Middle Adulthood.”;

Chapter 9–Late Adulthood/Senior Years
Late Adulthood/Senior Years Extend from age sixty-six until the end of life.

Late adulthood spans the time when we reach our mid-sixties until death. This is the longest developmental stage across the lifespan. In this chapter, we will consider the growth in numbers for those in late adulthood, how that number is expected to change in the future, and the consequences this will have for both the United States and the world. We will also examine several theories of human aging, the physical, cognitive, and socioemotional changes that occur with this population, and the vast diversity among those in this developmental stage. Further, ageism and many of the myths associated with those in late adulthood will be explored.

Late Adulthood in America
Late adulthood, which includes those aged 65 years and above, is the fastest growing age division of the United States. Currently, one in seven Americans is 65 years of age or older. The first of the baby boomers (born from 1946-1964) turned 65 in 2011, and approximately 10,000 baby boomers turn 65 every day. By the year 2050, almost one in four Americans will be over 65, and will be expected to live longer than previous generations. According to the U. S. Census Bureau a person who turned 65 in 2015 can expect to live another 19 years, which is 5.5 years longer than someone who turned 65 in 1950. This increasingly aged population has been referred to as the “graying of America”. This “graying” is already having significant effects on the nation in many areas, including work, health care, housing, social security, caregiving, and adaptive technologies. Table 10.1 shows the 2012, 2020, and 2030 projected percentages of the U.S. population ages 65 and older.

Table 1 Percent of United States Population 65 Years and Older
The “Graying” of the World
Even though the United States is aging, it is still younger than most other developed countries. Germany, Italy, and Japan all had at least 20% of their population aged 65 and over in 2012, and Japan had the highest percentage of elderly. Additionally, between 2012 and 2050, the proportion aged 65 and over is projected to increase in all developed countries. Japan is projected to continue to have the oldest population in 2030 and 2050. Table 10.2 shows the percentages of citizens aged 65 and older in select developed countries in 2012 and projected for 2030 and 2050.
According to the National Institute on Aging, there are 524 million people over 65 worldwide. This number is expected to increase from 8% to 16% of the global population by 2050. Between 2010 and 2050, the number of older people in less developed countries is projected to increase more than 250%, compared with only a 71% increase in developed countries. Declines in fertility and improvements in longevity account for the percentage increase for those 65 years and older. In more developed countries, fertility fell below the replacement rate of two live births per woman by the 1970s, down from nearly three children per woman around 1950. Fertility rates also fell in many less developed countries from an average of six children in 1950 to an average of two or three children in 2005. In 2006, fertility was at or below the two-child replacement level in 44 less developed countries.

In total number, the United States is projected to have a larger older population than the other developed nations, but a smaller older population compared with China and India, the world’s two most populous nations. By 2050, China’s older population is projected to grow larger than the total U.S. population today. As the population ages, concerns grow about who will provide for those requiring long-term care. In 2000, there were about 10 people 85 and older for every 100 persons between ages 50 and 64. These midlife adults are the most likely care providers for their aging parents. The number of old requiring support from their children is expected to more than double by the year 2040. These families will certainly need external physical, emotional, and financial support in meeting this challenge.

Age Periods during Late Adulthood
Late adulthood encompasses a long period, from age 60 potentially to age 120– sixty years! Researchers recognize that within that time period, from age 60 until death, there are multiple ages or sub-periods, that can be distinguished based on differences in peoples’ typical physical health and mental functioning during those age periods. In this chapter, we will be dividing the stage into four age periods: Young–old (60-74), old-old (75-84), the oldest-old (85-99), and centenarians (100+). These categories are based on the conceptions of aging including, biological, psychological, social, and chronological differences. They also reflect the increase in longevity of those living to this latter stage.

Young-old (60-74). Generally, this age span includes many positive aspects and is considered the “golden years” of adulthood. When compared to those who are older, the young-old experience relatively good health and social engagement, knowledge and expertise, and adaptive flexibility in daily living. The young-old also show strong performance in attention, memory, and crystallized intelligence. In fact, those identified as young-old are more similar to those in midlife. This group is less likely to require long-term care, to be dependent or poor, and more likely to be married, working for pleasure rather than income, and living independently. Overall, those in this age period feel a sense of happiness and emotional well-being that is better than at any other period of adulthood. It is also an unusual age in that people are considered both in old age and not in old age.

Old-old (75-84). Adults in this age period are likely to be living independently, but often experience physical impairments since chronic diseases increase after age 75. For example, congestive heart failure is 10 times more common in people 75 and older, than in younger adults. In fact, half of all cases of heart failure occur in people after age. In addition, hypertension and cancer rates are also more common after 75, but because they are linked to lifestyle choices, they typically can be can prevented, lessoned, or managed.

Oldest-old (85-99). Among the older adult population. this age group often includes people who have more serious chronic ailments. In the U.S., the oldest-old represented 14% of the older adult population in 2015. This age group is one of the fastest growing worldwide and is projected to increase more than 300% over its current levels. It is projected that there will be nearly 18 million in oldest-old age group by 2050, or about 4.5% of the U. S. population, compared with less than 2% of the population today. Females comprise more than 60% of those 85 and older, but they also suffer from more chronic illnesses and disabilities than older males.

While this age group accounts for only 2% of the U. S. population, it accounts for 9% of all hospitalizations. In a study of over 64,000 patients age 65 and older who visited an emergency department, the admission rates increased with age. Thirty-five percent of admissions after an emergency room visit were the young old, almost 43% were the old-old, and nearly half were the oldest-old. The most common reasons for hospitalization for the oldest-old were congestive heart failure, pneumonia, urinary tract infections, septicemia, stroke, and hip fractures. In recent years, hospitalizations for many of these medical problems have been reduced. However, hospitalization for urinary tract infections and septicemia has increased for those 85 and older. The mortality rate was also higher with age.

Those 85 and older are more likely to require long-term care and to be in nursing homes than the youngest-old. Almost 50% of the oldest-old require some assistance with daily living activities. However, most still live in the community rather than a nursing home. The oldest-old are less likely to be married and living with a spouse compared with the majority of the young-old. Gender is also an important factor in the likelihood of being married or living with one’s spouse.

Centenarians (100+) A segment of the oldest-old are centenarians, that is, 100 or older, and some are also referred to as supercentarians, those 110 and older. In 2015 there were nearly half a million centenarians worldwide, and it is estimated that this age group will grow to almost 3.7 million by 2050. The U. S. has the most centenarians, but Japan and Italy have the most per capita. Most centenarians tended to be healthier than many of their peers as they were growing older, and often there was a delay in the onset of any serious disease or disability until their 90s. Additionally, 25% reached 100 with no serious chronic illnesses, such as depression, osteoporosis, heart disease, respiratory illness, or dementia. Centenarians are more likely to experience a rapid terminal decline in later life, meaning that for most of their adulthood, and even older adult years, they are relatively healthy in comparison to many other older adults. According to Guinness World Records, Jeanne Louise Calment has been documented to be the longest living person at 122 years and 164 days old.

Psychosocial Development during Late Adulthood
Developmental Task of Late Adulthood: Integrity vs. Despair

Erikson framed the last part of the lifespan with the developmental task of Integrity versus Despair. In terms of psychosocial development, the tasks of adulthood were about becoming the self that you want to become (i.e., Identity) and creating the life you want to live, including establishing or maintaining the close interpersonal relationships that will be crucial to your physical and psychological health and well -being (i.e., Intimacy). The value of that life project is negotiated during middle adulthood in the search for meaning and a purpose larger than yourself that will contribute to your legacy (i.e., Generativity). So in old age, this final task basically comes down to whether you have built a life and constructed a self that is sufficient to withstand the disintegration of your physical body, the death of many of those you love, and eventually and inevitably, strong enough to face your own impending death with dignity and grace.

Like all psychosocial tasks, this one has two potential resolutions: Integrity, or a sense of self-acceptance, contentment with life and imminent death versus Despair, or a lack of fulfillment or peace and the inability to come to terms with life, aging, and approaching death. Development during elderhood, as during all developmental periods, is a bio-psycho-social process that takes place in specific societal and historical contexts. But this task, at the end of life, offers offers us the prospect of lifting off of those geographical, societal, and temporal limitations. We have the potential to transcend them, to establish a sense of wholeness and acceptance by getting in touch with our universal connection to humanity, past, present, and future. Like birth, death is a journey that every single one of us will take.

Erikson’s Ninth Stage of Psychosocial Development

Erikson collaborated with his wife, Joan, throughout much of his work on psychosocial development. In the Eriksons’ older years, they re-examined the eight stages and generated additional ideas about how development evolves during a person’s 80s and 90s. After Erik Erikson passed away in 1994, Joan published a chapter on the ninth stage of development, in which she proposed (from her own experiences and Erikson’s notes) that older adults revisit the previous eight stages and deal with the previous conflicts in new ways, as they cope with the physical and social changes of growing old. In the first eight stages, all of the conflicts are presented in a syntonic-dystonic matter, meaning that the first term listed in the conflict is the positive, sought-after achievement and the second term is the less-desirable goal (i.e., trust is more desirable than mistrust and integrity is more desirable than despair).

During the ninth stage, the Erikson’s argue that the dystonic, or less desirable outcome, come to take precedence again. For example, an older adult may become mistrustful (trust vs. mistrust), feel more guilt about not having the abilities to do what they once did (initiative vs. guilt), feel less competent compared with others (industry vs. inferiority), lose a sense of identity as they become dependent on others (identity vs. role confusion), become increasingly isolated (intimacy vs. isolation), and feel that they have less to offer society (generativity vs. stagnation). The Eriksons found that those who successfully come to terms with these changes and adjustments in later life make headway towards gerotranscendence, a term coined by gerontologist Lars Tornstam to represent a greater awareness of one’s own life and connection to the universe, increased ties to the past, and a positive, transcendent, perspective about life.

Psychologists and sociologist have long wondered how people manage to age successfully, and many theories have been put developed that highlight the keys to successful aging. We examine five: (1) Activity theory; (2) Continuity theory; (3) Socioemotional selectivity theory; (4) Selective optimization with compensation; and (5) Developmental self-regulation theory.

1. Developed by Havighurst and Albrecht in 1953, activity theory addresses the issue of how persons can best adjust to the changing circumstances of old age–e.g., retirement, illness, loss of friends and loved ones through death, and so on. In addressing this issue, they recommend that older adults involve themselves in voluntary and leisure organizations, child care and other forms of social interaction. Activity theory thus strongly supports the avoidance of a sedentary lifestyle and considers it essential to health and happiness that the older person remains active physically and socially. In other words, the more active older adults are the more stable and positive their self-concept will be, which will then lead to greater life satisfaction and higher morale. Activity theory suggests that many people are barred from meaningful experiences as they age, but older adults who continue find ways to remain active can work toward replacing lost opportunities with new ones.
2. Continuity theory suggests as people age, they continue to view the self in much the same way as they did when they were younger. An older person’s approach to problems, goals, and situations is much the same as it was when they were younger. They are the same individuals, but simply in older bodies. Consequently, older adults continue to maintain their identity even as they give up previous roles. For example, a retired Coast Guard commander attends reunions with shipmates, stays interested in new technology for home use, is meticulous in the jobs he does for friends or at church, and displays mementos from his experiences on the ship. He is able to maintain a sense of self as a result. People do not give up who they are as they age. Hopefully, they are able to share these aspects of their identity with others throughout life. Focusing on what a person is still able to do and pursuing those interests and activities is one way to optimize and maintain self-identity.
3. The Socioemotional Selectivity Theory focuses on changes in motivation for actively seeking social contact with. This theory proposes that with increasing age, our motivational goals change based on how much time we have left to live. Rather than focusing on acquiring information from many diverse social relationships, as adolescents and young adults tend to do, older adults focus on the emotional aspects of relationships. To optimize the experience of positive affect, older adults actively restrict their social life to prioritize time spent with emotionally close significant others. In line with this theory, older marriages are found to be characterized by enhanced positive and reduced negative interactions and older partners show more affectionate behavior during conflict discussions than do middle-aged partners. Research showing that older adults have smaller networks compared to young adults, and tend to avoid negative interactions, also supports this theory.
4. Selective Optimization with Compensation is a strategy for improving health and well being in older adults and a model for successful aging. It is recommended that seniors select and optimize their best abilities and most intact functions while compensating for declines and losses. This means, for example, that a person who can no longer drive, is able to find alternative transportation, or a person who is compensating for having less energy, learns how to reorganize the daily routine to avoid over-exertion. Perhaps nurses and other allied health professionals working with this population will begin to focus more on helping patients remain independent by optimizing their best functions and abilities rather than simply treating illnesses. Promoting health and independence are essential for successful aging.
5. Developmental Self-regulation Theory is a dual-process model that could have been based on St. Augustine’s serenity prayer. On the one hand, is primary control, or the strength and courage to take action to change the things that can be changed. This includes a sense of self-efficacy to take action needed to make lifestyle changes or undergo treatments that optimize functioning, such as a healthy diet, exercise, medical treatments (like taking one’s insulin or cataract surgery), or adopting outside aids like a cane or walker. The second process is called accommodation, and it involves the grace to accept the things that cannot be changed. This attitude of willing acceptance includes understanding, gratitude for times past, and a focus on the positive things that still remain. Such accommodation can be contrasted with furious resentment or depressed resignation to the losses of aging. In fact, some researchers argue that depression in old age is often due, not to the losses of control aging inevitably entails, but from an inability to accommodate, that is, to relinquish activities and goals that are no longer feasible.

Generativity in Late Adulthood
People in late adulthood continue to be productive in many ways. These include work, education, volunteering, family life, and intimate relationships. Older adults also experience generativity (recall Erikson’s previous stage of generativity vs. stagnation) through voting, forming and helping social institutions like community centers, churches and schools. Thinking of the issue of legacy, psychoanalyst Erik Erikson wrote “I am what survives me”.

Productivity in Work
Some older people continue to be productive in work. Mandatory retirement is now illegal in the United States. However, many do choose retirement by age 65. Most people leave work by choice, and the primary factors that influence decisions about when to retire are health status, finances, and satisfaction at work. Those who do leave by choice adjust to retirement more easily. Chances are, they have prepared for a smoother transition by gradually giving more attention to an avocation or interest as they approach retirement. And they are more likely to be financially ready to retire. Those who must leave abruptly for health reasons or because of layoffs or downsizing have a more difficult time adjusting to their new circumstances. Men, especially, can find unexpected retirement difficult.

Women may feel less of an identify loss after retirement because much of their identity may have come from family roles as well. At the same time, however, women tend to have poorer retirement funds accumulated from work and if they take their retirement funds in a lump sum (be that from their own or from a deceased husband’s funds), are more at risk of outliving those funds. Because they will on average live longer, women need better financial planning in retirement. Sixteen percent of adults over 65 were in the labor force in 2008. Globally, 6.2% are in the labor force and this number is expected to reach 10.1 million by 2016. Many adults 65 and older continue to work either full-time or part-time either for income or pleasure or both. In 2003, 39% of full-time workers over 55 were women over the age of 70; 53% were men over 70. This increase in numbers of older adults is likely to mean that more will continue to part of the workforce in years to come.

Volunteering: Face-to-face and Virtually
About 40% of older adults are involved in some type of structured, face-to-face, volunteer work. But many older adults, about 60%, engage in a sort of informal type of volunteerism, helping out neighbors or friends rather than working in an organization. They may help a friend by taking them somewhere or shopping for them, etc. Some do participate in organized volunteer programs but interestingly enough, those who do tend to work part-time as well. Those who retire and do not work are less likely to feel that they have a contribution to make. (It’s as if when one gets used to staying at home, one’s confidence to go out into the world diminishes.) And those who have recently retired are more likely to volunteer than those over 75 years of age. New opportunities exist for older adults to serve as virtual volunteers by dialoguing online with others from around their world and sharing their support, interests, and expertise. According to an article from the American Association of Retired Persons (AARP), virtual volunteerism has increased from 3,000 participants in 1998 to over 40,000 in 2005. These volunteer opportunities range from helping teens with their writing to communicating with ‘neighbors’ in villages in developing countries. Virtual volunteering is available to those who cannot engage in face-to-face interactions and opens up a new world of possibilities and ways to connect, maintain identity, and be productive.

Relationship with Adult Children
Many older adults provide financial assistance and/or housing to adult children. at this point in history, there is more support going from the older parent to the younger adult children than in the other direction. In addition to providing for their own children, many elders are raising their grandchildren. Consistent with socioemotional selectivity theory, older adults seek, and are helped by, their adult children providing emotional support. Lang and Schütze, as part of the Berlin Aging Study (BASE), surveyed adult children (mean age 54) and their aging parents (mean age 84). They found that the adult children of older parents who provided emotional support, such as showing tenderness toward their parent, cheering the parent up when he or she was sad, tended to report greater life satisfaction. In contrast, older adults whose children provided informational support, such as providing advice to the parent, reported less life satisfaction. Lang and Schütze found that older adults wanted their relationship with their children to be more emotionally meaningful, but they did not want their children telling them what to do. Daughters and adult children who were younger, tended to provide such support more than sons and adult children who were older. Lang and Schütze also found that adult children who were more autonomous rather than emotionally dependent on their parents, had more emotionally meaningful relationships with their parents, from both the parents’ and adult children’s point of view.

Friendships
Friendships are not formed in order to enhance status or careers, and may be based purely on a sense of connection or the enjoyment of being together. Most elderly people have at least one close friend. These friends may provide emotional as well as physical support. Being able to talk with friends and rely on others is very important during this stage of life. Bookwala, Marshall, and Manning found that the availability of a friend played a significant role in protecting women’s health from the impact of widowhood. Specifically, those who became widowed and had a friend as a confidante, reported significantly lower somatic depressive symptoms, better self-rated health, and fewer sick days in bed than those who reported not having a friend as a confidante. In contrast, having a family member as a confidante did not provide health protection for those recently widowed.

Education
Twenty percent of people over 65 have a bachelors or higher degree. And over 7 million people over 65 take adult education courses. Enriching experiences of lifelong learning are offered through continuing education programs on college campuses or programs known as “Elderhostels” which allow older adults to travel abroad, live on campus, and study. Academic courses as well as practical skills such as computer classes, foreign languages, budgeting, and holistic medicines are among the courses offered. Older adults who have higher levels of education are more likely to take continuing education. But offering more educational experiences to a diverse group of older adults, including those who are institutionalized in nursing homes, can enhance elder students’ quality of life.

Religious Activities
People tend to become more involved in prayer and religious activities as they age. This provides a social network as well as a belief system which can combat the fear of death. Religious activities provide a focus for volunteerism and other activities as well. For example, one elderly woman prides herself on knitting prayer shawls that are given to those who are sick. Another serves on the alter guild and is responsible for keeping robes and linens clean and ready for communion.

Political Activism
The elderly are very politically active. They have high rates of voting and engage in letter writing to congress on issues that not only affect them, but on a wide range of domestic and foreign concerns. In the past three presidential elections, over 70 percent of people 65 and older showed up at the polls to vote.

Loneliness or Solitude
Loneliness is the discrepancy between the social contact a person has and the contacts a person wants. It can result from social or emotional isolation. Women tend to experience loneliness due to social isolation; men from emotional isolation. Loneliness can be accompanied by a lack of self-worth, impatience, desperation, and depression. Being alone does not always result in loneliness. For some, being alone means solitude. Solitude involves gaining self-awareness, taking care of the self, being comfortable alone, and pursuing one’s interests. In contrast, loneliness is perceived social isolation.

For those in late adulthood, loneliness can be especially detrimental. Novotney reviewed the research on loneliness and social isolation and found that loneliness was linked to a 40% increase in the risk for dementia and a 30% increase in the risk of stroke or coronary heart disease. This was hypothesized to be due to reasons that were both biological (e.g., a rise in stress hormones), psychological (e.g., depression and anxiety), as well as social (e.g., the individual lacks encouragement from others to engage in healthy behaviors). In contrast, older adults who take part in social clubs and church groups have a lower risk of death. Opportunities to reside in mixed age housing and continuing to feel like a productive member of society have also been found to decrease feelings of social isolation, and thus loneliness.

Late Adult Lifestyles
Marriage. As can be seen in Figure 1, the most common living arrangement for older adults in 2017 was marriage. This status was more common for older men than for older women, who based on differences in average life expectancy, typically outlive their husbands.

Divorce. As noted previously, older adults are divorcing at higher rates than in prior generations. However, adults age 65 and over are still less likely to divorce than middle-aged and young adults. Divorce poses a number of challenges for older adults, especially women, who are more likely to experience financial difficulties and are more likely to remain single than are older men. However, in both America and England, studies have found that the adult children of divorcing parents offer more support and care to their mothers than their fathers. While divorced, older men may be better off financially and are more likely to find another partner, so they may receive less support from their adult children.
Figure 1 Marital status: Age 65+ in 2017

Dating. Due to changing social norms and shifting cohort demographics, it has become more common for single older adults to be involved in dating and romantic relationships. An analysis of widows and widowers ages 65 and older found that 18 months after the death of a spouse, 37% of men and 15% of women were interested in dating. Unfortunately, opportunities to develop close relationships often diminish in later life as social networks decrease because of retirement, relocation, and the death of friends and loved ones. Consequently, older adults, much like those younger, are increasing their social networks using technologies, including e-mail, chat rooms, and online dating sites.

Interestingly, older men and women parallel online dating information as those younger. Alterovitz and Mendelsohn analyzed 600 internet personal ads from different age groups, and across the life span, men sought physical attractiveness and offered status-related information more than women. With advanced age, men desired women increasingly younger than themselves, whereas women desired older men until ages 75 and over, when they sought men younger than themselves. Research has previously shown that older women in romantic relationships are not interested in becoming a caregiver or becoming widowed for a second time.

Additionally, older men are more eager to repartner than are older women. Concerns expressed by older women included not wanting to lose their autonomy, care for a potentially ill partner, or merge their finances with someone. Older dating adults also need to know about threats to sexual health, including being at risk for sexually transmitted diseases, including chlamydia, genital herpes, and HIV. Nearly 25% of people living with HIV/AIDS in the United States are 50 or older. Githens and Abramsohn found that only 25% of adults 50 and over who were single or had a new sexual partner used a condom the last time they had sex. Robin stated that 40% of those 50 and over have never been tested for HIV. These results indicate that educating all individuals, not just adolescents, on healthy sexual behavior is important.

Remarriage and Cohabitation. Older adults who remarry often find that their remarriages are more stable than those of younger adults. Kemp and Kemp suggest that greater emotional maturity may lead to more realistic expectations regarding marital relationships, leading to greater stability in remarriages in later life. Older adults are also more likely to be seeking companionship in their romantic relationships. Carr found that older adults who have considerable emotional support from their friends were less likely to seek romantic relationships. In addition, older adults who have divorced often desire the companionship of intimate relationships without marriage. As a result, cohabitation is increasing among older adults, and like remarriage, cohabitation in later adulthood is often associated with more positive consequences than it is in younger age groups. No longer being interested in raising children, and perhaps wishing to protect family wealth, older adults may see cohabitation as a good alternative to marriage. In 2014, 2% of adults age 65 and up were cohabitating.

Living Apart Together. In addition to cohabiting there has been an increase in living apart together (LAT), which is “a monogamous intimate partnership between unmarried individuals who live in separate homes but identify themselves as a committed couple”. This trend has been found in several nations and is motivated by:
-A strong desire to be independent in day-to-day decisions
-Maintaining their own home
-Keeping boundaries around established relationships
-Maintaining financial stability

Besides the desire to be autonomous, there is also a need for companionship, sexual intimacy, and emotional support. According to Bensen and Coleman, there are differences in LAT among older and younger adults. Those who are younger often enter into LAT out of circumstances, such as the job market, and they frequently view this arrangement as a transitional stage. In contrast, 80% of older adults reported that they did not wish to cohabitate or marry. For some it was a conscious choice to live more independently. For instance, older women desired the LAT lifestyle as a way of avoiding the traditional gender roles that are often inherent in relationships where couples live together. However, some older adults become LATs because they fear social disapproval from others if they were to live together.

Gay and Lesbian Elders
Approximately 3 million older adults in the United States identify as lesbian or gay. By 2025 that number is expected to rise to more than 7 million. Despite the increase in numbers, older lesbian and gay adults are one of the least researched demographic groups, and the research there is portrays a population faced with discrimination. According to the Centers for Disease Control and Prevention, compared to heterosexuals, lesbian and gay adults experience disparities in both physical and mental health. More than 40% of lesbian and gay adults ages 50 and over suffer from at least one chronic illness or disability and compared to heterosexuals they are more likely to smoke and binge drink. Additionally, gay older adults have an increased risk of prostate cancer and infection from HIV and other sexually transmitted illnesses. When compared to heterosexuals, lesbian and gay elders have less support from others as they are twice as likely to live alone and four times less likely to have adult children.

Lesbian and gay older adults who belong to ethnic and cultural minorities, conservative religions, and rural communities may face additional stressors. Ageism, heterocentrism, sexism, and racism can combine cumulatively and impact the older adult beyond the negative impact of each individual form of. David and Knight found that older gay black men reported higher rates of racism than younger gay black men and higher levels of perceived ageism than older gay white men.

LGBT Elder Care. Approximately 7 million LGBT people over age 50 will reside in the United States by 2030, and 4.7 million of them will need elder care. Decisions regarding elder care is often left for families, and because many LGBT people are estranged from their families and do not have children of their own, they are left in a vulnerable position when seeking living arrangements. A history of discriminatory policies, such as housing restricted to married individuals involving one man and one woman, and stigma associated with LGBT people make them especially vulnerable to negative housing experiences when looking for elder care.

Although lesbian and gay older adults face many challenges, more than 80% indicate that they engage in some form of wellness or spiritual activity. They also gather social support from friends and “family members by choice” rather than legal or biological relatives. This broader social network provides extra support to gay and lesbian elders.

An important consideration when reviewing the development of gay and lesbian older adults is the cohort in which they grew up. The oldest lesbian and gay adults came of age in the 1950’s when there were no laws to protect them from victimization. The baby boomers, who grew up in the 1960’s and 1970’s, began to see states repeal laws that criminalized homosexual behavior. Future lesbian and gay elders will have different experiences due to the legal right for same-sex marriage and greater societal acceptance. Consequently, just like all those in late adulthood, understanding that gay and lesbian elders are a heterogeneous population is important when understanding their overall development.

Physical Development
Physical Changes of Aging
The Baltimore Longitudinal Study on Aging (BLSA) began in 1958 and has traced the aging process in 1,400 people from age 20 to 90. Researchers from the BLSA have found that the aging process varies significantly from individual to individual and from one organ system to another. However, some key generalization can be made including:
-Heart muscles thicken with age
-Arteries become less flexible
-Lung capacity diminishes
-Kidneys become less efficient in removing waste from the blood
-Bladder loses its ability to store urine
-Brain cells also lose some functioning, but new neurons can also be produced.

Many of these changes are determined by genetics, lifestyle, and disease. Other changes in late adulthood include:
Body Changes. Everyone’s body shape changes naturally as they age. According to the National Library of Medicine after age 30 people tend to lose lean tissue, and some of the cells of the muscles, liver, kidney, and other organs are lost. Tissue loss reduces the amount of water in the body and bones may lose some of their minerals and become less dense (a condition called osteopenia in the early stages and osteoporosis in the later stages). The amount of body fat goes up steadily after age 30, and older individuals may have almost one third more fat compared to when they were younger. Fat tissue builds up toward the center of the body, including around the internal organs.

Skin, Hair and Nails. With age skin loses fat, and becomes thinner, less elastic, and no longer looks plump and smooth. Veins and bones can be seen more easily, and scratches, cuts, and bumps can take longer to heal. Years of exposure to the sun may lead to wrinkles, dryness, and cancer. Older people may bruise more easily, and it can take longer for these bruises to heal. Some medicines or illnesses may also cause bruising. Gravity can cause skin to sag and wrinkle, and smoking can wrinkle skin as well. Also, seen in older adulthood are age spots, previously called “liver spots”. They look like flat, brown spots and are often caused by years in the sun. Skin tags are small, usually flesh-colored growths of skin that have a raised surface. They become common as people age, especially for women, but both age spots and skin tags are harmless.

Nearly everyone has hair loss as they age, and the rate of hair growth slows down as many hair follicles stop producing new hairs. The loss of pigment and subsequent graying begun in middle adulthood continues during late adulthood. The body and face also lose hair. Facial hair may grow coarser. For women this often occurs around the chin and above the upper lip. For men the hair of the eyebrows, ears, and nose may grow longer. Nails, particularly toenails, may become hard and thick. Lengthwise ridges may develop in the fingernails and toenails. However, pits, lines, changes in shape or color of fingernails should be checked by a healthcare provider as they can be related to nutritional deficiencies or kidney disease.

Height and Weight. The tendency to become shorter as one ages occurs among all races and both sexes. Height loss is related to aging changes in the bones, muscles, and joints. A total of 1 to 3 inches in height is lost with aging. People typically lose almost one-half inch every 10 years after age 40, and height loss is even more rapid after age 70. Changes in body weight vary for men and woman. Men often gain weight until about age 55, and then begin to lose weight later in life, possibly related to a drop in the male sex hormone testosterone. Women usually gain weight until age 65, and then begin to lose weight. Weight loss later in life occurs partly because fat replaces lean muscle tissue, and fat weighs less than muscle. Diet and exercise are important factors in weight changes in late adulthood.

Sarcopenia is the loss of muscle tissue as a natural part of aging. Sarcopenia is most noticeable in men, and physically inactive people can lose as much as 3% to 5% of their muscle mass each decade after age 30, but even people who are active still lose muscle. Symptoms include a loss of stamina and weakness, which can decrease physical activity and subsequently shrink muscles further. Sarcopenia typically increases around age 75, but it may also speed up as early as 65 or as late as 80. Factors involved in sarcopenia include a reduction in nerve cells responsible for sending signals to the muscles from the brain to begin moving, a decrease in the ability to turn protein into energy, and not receiving enough calories or protein to sustain adequate muscle mass. Any loss of muscle is important because it lessens strength and mobility, and sarcopenia is a factor in frailty and the likelihood of falls and fractures in older adults. Maintaining strong leg and heart muscles are important for independence. Weight-lifting, walking, swimming, or engaging in other cardiovascular exercises can help strengthen muscles and prevent atrophy.

Sensory Changes in Late Adulthood
Vision. In late adulthood, all the senses show signs of decline, especially among the oldest-old. In the last chapter, you read about the visual changes that were beginning in middle adulthood, such as presbyopia, dry eyes, and problems seeing in dimmer light. By later adulthood these changes are much more common. Three serious eyes diseases are also more common in older adults: cataracts, macular degeneration, and glaucoma. Only the first can be effectively cured in most people.

Cataracts are a clouding of the lens of the eye. The lens of the eye is made up of mostly water and protein. The protein is precisely arranged to keep the lens clear, but with age some of the protein starts to clump. As more of the protein clumps together the clarity of the lens is reduced. While some adults in middle adulthood may show signs of cloudiness in the lens, the area affected is usually small enough not to interfere with vision. More people have problems with cataracts after age 60 and by age 75, 70% of adults will have problems with cataracts. Cataracts also cause a discoloration of the lens, tinting it more yellow and then brown, which can interfere with the ability to distinguish colors such as black, brown, dark blue, or dark purple.

Risk factors besides age include certain health problems such as diabetes, high blood pressure, and obesity, behavioral factors such as smoking, other environmental factors such as prolonged exposure to ultraviolet sunlight, previous trauma to the eye, long-term use of steroid medication, and a family history of cataracts. Cataracts are treated by removing and replacing the lens of the eye with a synthetic lens. In developed countries, such as the United States, cataracts can be easily treated with surgery.

However, in developing countries, access to such operations are limited, making cataracts the leading cause of blindness in late adulthood in the least developed countries. As shown in Figure 2, in areas of the world with limited medical treatment for cataracts, people are living more years with a serious disability. For example, of those living in the darkest red color on the map, more than 990 out of 100,00 people have a shortened lifespan due to the disability caused by cataracts.
Figure 2
Older adults are also more likely to develop age-related macular degeneration, which is the loss of clarity in the center field of vision, due to the deterioration of the macula, the center of the retina. Macular degeneration does not usually cause total vision loss, but the loss of the central field of vision can greatly impair day-to-day functioning. There are two types of macular degeneration: dry and wet. The dry type is the most common form and occurs when tiny pieces of a fatty protein called drusen form beneath the retina. Eventually the macular becomes thinner and stops working properly. About 10% of people with macular degeneration have the wet type, which causes more damage to their central field of vision than the dry form. This form is caused by an abnormal development of blood vessels beneath the retina. These vessels may leak fluid or blood causing more rapid loss of vision than the dry form.

The risk factors for macular degeneration include smoking, which doubles your risk; race, as it is more common among Caucasians than African Americans or Hispanics/Latinos; high cholesterol; and a family history of macular degeneration. At least 20 different genes have been related to this eye disease, but there is no simple genetic test to determine your risk, despite claims by some genetic testing companies. At present, there is no effective treatment for the dry type of macular degeneration. Some research suggests that some patients may benefit from a cocktail of certain antioxidant vitamins and minerals, but results are mixed at best. They are not a cure for the disease nor will they restore the vision that has been lost. This “cocktail” can slow the progression of visual loss in some people. For the wet type, medications that slow the growth of abnormal blood vessels and surgery, such as laser treatment to destroy the abnormal blood vessels, may be used. Unfortunately, only 25% of those with the wet version typically see improvement with these procedures.

A third vision problem that increases with age is glaucoma, which is the loss of peripheral vision, frequently due to a buildup of fluid in eye that damages the optic nerve. As we age the pressure in the eye may increase causing damage to the optic nerve. The exterior of the optic nerve receives input from retinal cells on the periphery, and as glaucoma progresses more and more of the peripheral visual field deteriorates toward the central field of vision. In the advanced stages of glaucoma, a person can lose their sight entirely. Fortunately, glaucoma tends to progresses slowly.

Glaucoma is the most common cause of blindness in the U.S.. African Americans over age 40, and everyone else over age 60, have a higher risk for glaucoma. Those with diabetes, and with a family history of glaucoma also have a higher risk. There is no cure for glaucoma, but its rate of progression can be slowed, especially with early diagnosis. Routine eye exams to measure eye pressure and examination of the optic nerve can detect both the risk and presence of glaucoma. Those with elevated eye pressure are given medicated eye drops. Reducing eye pressure lowers the risk of developing glaucoma or slow its progression in those who already have it.

Hearing. As you read previously, our hearing declines both in terms of the frequencies of sound we can detect, and the intensity of sound needed to hear as we age. These changes continue in late adulthood. Almost 1 in 4 adults aged 65 to 74 and 1 in 2 aged 75 and older have disabling hearing loss. Table 10.3 lists some common signs of hearing loss.

Table 3 Common Signs of Hearing Loss

Presbycusis is a common form of hearing loss in late adulthood that results in a gradual loss of hearing. It runs in families and affects hearing in both ears. Older adults may also notice tinnitus, a ringing, hissing, or roaring sound in the ears. The exact cause of tinnitus is unknown, although it can be related to hypertension and allergies. It may come and go or persist and get worse over time. The incidence of both presbycusis and tinnitus increase with age and males around the world have higher rates of both.

Your auditory system has two jobs: To help you to hear, and to help you maintain balance. Your balance is controlled when the brain receives information from the shifting of hair cells in the inner ear about the position and orientation of the body. With age, the functionality of the inner ear declines, which can lead to problems with balance when sitting, standing, or moving.

Taste and Smell. Our sense of taste and smell are part of our chemical sensing system. Our sense of taste, or gustation, appears to age well. Normal taste occurs when molecules that are released by chewing food stimulate taste buds along the tongue, the roof of the mouth, and in the lining of the throat. These cells send messages to the brain, where specific tastes are identified. After age 50, we start to lose some of these sensory cells. Most people do not notice any changes in taste until their 60s. Given that the loss of taste buds is very gradual, even in late adulthood, many people are often surprised that their loss of taste is most likely the result of a loss of smell.

Our sense of smell, or olfaction, decreases with age, and problems with the sense of smell are more common in men than in women. Almost 1 in 4 males in their 60s have a disorder with the sense of smell, compared to 1 in 10 women. This loss of smell due to aging is called presbyosmia. Olfactory cells are located in a small area high in the nasal cavity. These cells are stimulated via two pathways: when we inhale through the nose, or via the connection between the nose and the throat when we chew and digest food. It is a problem with this second pathway that explains why some foods such as chocolate or coffee seem tasteless when we have a head cold. There are several types of loss of smell. Total loss of smell, or anosmia, is extremely rare.

Problems with our chemical senses can be linked to other serious medical conditions such as Parkinson’s, Alzheimer’s, or multiple sclerosis. Any sudden changes in sensory sensitivity should be checked out. Loss of smell can change a person’s diet, with either a loss of enjoyment of food and eating too little for balanced nutrition, or adding sugar and salt to foods that are becoming blander to the palette.

Table 4 Types of Smell Disorders

Touch. Research has found that with age, people may experience reduced or changed sensations of vibration, cold, heat, pressure, and pain. Many of these changes are also consistent with a number of medical conditions that are more common among the elderly, such as diabetes. However, there are also changes in touch sensations among healthy older adults. The ability to detect changes in pressure have been shown to decline with age, with more pronounced losses during the 6th decade and diminishing further with advanced age. Yet, there is considerable variability, with almost 40% of the elderly showing sensitivity that is comparable to younger adults. However, the ability to detect the roughness/ smoothness or hardness/softness of an object shows no appreciable change with age. Those who show decreasing sensitivity to pressure, temperature, or pain are at risk for injury, as they can injure themselves without detecting it.

Pain. According to Molton and Terril, approximately 60%-75% of people over the age of 65 report at least some chronic pain, and this rate is even higher for those individuals living in nursing homes. Although the presence of pain increases with age, older adults are less sensitive to pain than younger. Farrell looked at research studies that included neuroimaging techniques involving older people who were healthy and those who experienced a painful disorder. Results indicated that there were age-related decreases in brain volume in those structures involved in pain. Especially noteworthy were changes in the prefrontal cortex, brainstem, and hippocampus.

Women are more likely to report feeling pain than men. Women have fewer opioid receptors in the brain, and women also receive less relief from opiate drugs. Because pain serves an important indicator that there is something wrong, a decreased sensitivity to pain in older adults is a concern because it can conceal illnesses or injuries requiring medical attention.

Chronic health problems, including arthritis, cancer, diabetes, joint pain, sciatica, and shingles are responsible for most of the pain felt by older adults. Cancer is a special concern, especially “breakthrough pain” which is a severe pain that comes on quickly while a patient is already medicated with a long-acting painkiller. It can be very upsetting, and after one attack many people worry it will happen again. Some older individuals worry about developing an addiction to pain medication, but if medicine is taken exactly as prescribed, addiction should not be a concern. Lastly, side effects from pain medicine, including constipation, dry mouth, and drowsiness, may occur that can adversely affect the elder’s life.

Some older individuals put off going to the doctor because they think pain is just part of aging and nothing can help. Of course, this is not usually true. Managing pain is crucial to ensure feelings of well-being for the older adult. When chronic pain is not managed, the individual tends to restrict their movements for fear of feeling pain or injuring themselves further. This lack of activity will result in more restriction, further decreased participation, and greater disability. A decline in physical activity because of pain is also associated with weight gain and obesity in adults. Additionally, sleep and mood disorders, such as depression, can occur. Learning to cope effectively with pain is an important consideration in late adulthood and working with one’s primary physician or a pain specialist is recommended.

Of those 65 and older, 35% have a disability. Figure 2 identifies the percentage of those who have a disability based on the type.

Figure 2 Percentage of adults 65 and older with a disability in 2017

Brain Functioning

Research has demonstrated that the brain loses 5% to 10% of its weight between 20 and 90 years of age. This decrease in brain volume appears to be due to the shrinkage of neurons, decreases in the number of synapses, and increasingly shorter axon lengths. According to Garrett, normal declines in cognitive ability throughout the lifespan are associated with brain changes, including reduced activity of genes involved in memory storage, synaptic pruning, plasticity, and glutamate and GABA (neurotransmitters) receptors.

There is also a loss in white matter connections between brain areas. Without myelin, neurons demonstrate slower conduction and impede each other’s actions. A loss of synapses occurs in specific brain areas, including the hippocampus (involved in memory) and the basal forebrain region. Older individuals also activate larger regions of their attentional and executive networks, located in the parietal and prefrontal cortex, when they perform complex tasks. This increased activation coincides with reduced performance on both executive tasks and tests of working memory when compared to that of younger people.

Continued Neurogenesis. Researchers at the University of Chicago found that new neurons continue to form into old age. Tobin examined post-mortem brain tissue of individuals between the ages of 79 and 99 (average age 90.6) and found evidence of neurogenesis in the hippocampus. Approximately 2000 neural progenitor cells and 150,000 developing neurons were found per brain, although the number of developing neurons was lower in people with cognitive impairments or Alzheimer’s disease. Tobin hypothesized that the lower levels of neurogenesis in the hippocampus were associated with symptoms of cognitive decline and reduced synaptic plasticity.

The brain in late adulthood also exhibits considerable plasticity, and through practice and training, the brain can be modified to compensate for any age-related changes. Park and Reuter-Lorenz proposed the Scaffolding Theory of Aging and Cognition which states that the brain adapts to neural atrophy (dying of brain cells) by building alternative connections, referred to as scaffolding. This scaffolding allows older brains to retain high levels of performance. Brain compensation is especially noted in the additional neural effort demonstrated by those individuals who are aging well. For example, older adults who performed just as well as younger adults on a memory task used both prefrontal areas, while only the right prefrontal cortex was used in younger participants. Consequently, this decrease in brain lateralization appears to assist older adults with their cognitive skills.

Healthy Brain Functioning. In longitudinal studies, Cheng found that both physical activity and stimulating cognitive activity resulted in significant reductions in the risk of neurocognitive disorders. Physical activity, especially aerobic exercise, is associated with less age-related gray and white matter loss, as well and diminished neurotoxins in the brain.

Overall, physical activity preserves the integrity of neurons and brain volume. Cognitive training improves the efficiency of the prefrontal cortex and executive functions, such as working memory, and strengthens the plasticity of neural circuits. Both activities support cognitive reserve, or “the structural and dynamic capacities of the brain that buffer against atrophies and lesions. Although it is optimal to begin physical and cognitive activities earlier in life, it is never too late to start these programs to improve one’s cognitive health, even in late adulthood.

Can we improve brain functioning? Many training programs have been created to improve brain functioning. ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly), a study conducted between 1999 and 2001 in which 2,802 individuals age 65 to 94, suggests that the answer is “yes”. These racially diverse participants received 10 group training sessions and 4 follow up sessions to work on tasks of memory, reasoning, and speed of processing. These mental workouts improved cognitive functioning even 5 years later. Many of the participants believed that this improvement could be seen in everyday tasks as well.

However, programs for the elderly on memory, reading, and processing speed training demonstrate that there is improvement on the specific tasks trained, but there is no generalization to other abilities. Further, these programs have not been shown to delay or slow the progression of Alzheimer’s disease. Although these programs are not harmful, “physical exercise, learning new skills, and socializing remain the most effective ways to train your brain” (p. 207). These activities appear to build a reserve to minimize the effects of primary aging of the brain.

Women and Aging
In Western society, aging for women is much more stressful than for men as society emphasizes youthful beauty and attractiveness. The description that aging men are viewed as “distinguished” and aging women are viewed as “old” is referred to as the double standard of aging. Since women have traditionally been valued for their reproductive capabilities, they may be considered old once they are postmenopausal. In contrast, men have traditionally been valued for their achievements, competence, and power, and therefore are not considered old until decades later when they are physically unable to work. Consequently, women experience more fear, anxiety, and concern about their identity as they age, and may feel pressure to prove themselves as productive and valuable members of society.

Attitudes about aging, however, do vary by race, culture, and sexual orientation. In some cultures, aging women gain greater social status. For example, as Asian women age they attain greater respect and have greater authority in the household. Compared to white women, Black and Latina women possess fewer stereotypes about aging. Lesbians are also more positive about aging and looking older than heterosexual women. The impact of media certainly plays a role in how women view aging by selling anti-aging products and supporting cosmetic surgeries to look younger.

Cognition, Wisdom, and Spirituality
How Does Aging Affect Information Processing?

There are many stereotypes regarding older adults– as forgetful and confused, but what does the research on memory and cognition in late adulthood reveal? Memory comes in many types, such as working, episodic, semantic, implicit, and prospective. There are also many processes involved in memory. Thus it should not be a surprise that there are declines in some types of memory and memory processes, while other areas of memory are maintained or even show some improvement with age. In this section, we will focus on changes in memory, attention, problem solving, intelligence, post-formal cognition, and wisdom, including the effects of stereotypes that exaggerate these losses in the elderly.

Memory
Changes in Working Memory. Working memory is the more active, effortful part of our memory system. Working memory is composed of three major systems: The phonological loop that maintains information about auditory stimuli, the visuospatial sketchpad, that maintains information about visual stimuli, and the central executive, that oversees working memory, allocating resources where needed and monitoring whether cognitive strategies are being effective.

Schwartz reports that it is the central executive that typically shows the most marked declines with age. In tasks that require allocation of attention between different stimuli, older adults fare worse than do younger adults. In a study by Göthe, Oberauer, and Kliegl older and younger adults were asked to learn two tasks simultaneously. Young adults eventually managed to learn and perform both tasks without any loss in speed and efficiency, although it did take considerable practice. None of the older adults were able to accomplish this. Yet, when asked to learn each task individually, older adults could perform just as well as young adults. Having older adults learn and perform both tasks together was just too taxing for the central executive. In contrast, in working memory tasks that do not require much input from the central executive, such as the digit span test, which predominantly uses the phonological loop, older adults perform on par with young adults.

Changes in Long-term Memory. Long-term memory is divided into semantic (knowledge of facts), episodic (memories of specific events), and implicit (stored procedural skills, classical conditioning, and priming) memory. Semantic and episodic memory are part of the explicit memory system, which requires conscious effort to create and retrieve. Several studies consistently reveal that episodic memory shows greater age-related declines than semantic memory.

It has been suggested that episodic memories may be harder to encode and retrieve because they contain at least two different types of memory (1) the event and (2) when and where the event took place. In contrast, semantic memories are not tied to any particular geography or time line. Thus, only the knowledge needs to be encoded or retrieved. Spaniol found that retrieval of semantic information was considerably faster for both younger and older adults than the retrieval of episodic information, with there being little difference between the two age groups for retrieval of semantic memories. They note that older adults’ poorer performance on episodic memory appeared to be related to slower processing of the information and the difficulty of the task. They found that as tasks became more difficult, the gap between the two age groups’ performance widened, but more so for tasks involving episodic than semantic memory tasks.

Studies that examine general knowledge (semantic memory) of topics such as politics and history or vocabulary/lexical memory often find that older adults outperform younger adults. However, older adults do find that they experience more “blocks” at retrieving information that they know. In other words, they experience more tip-of-the-tongue (TOT) events than do younger adults. memory blocks are especially common for the retrieval of “nonsense words”or specific concept labels. Unfortunately for older adults, nonsense words include the names of people, places, and things (like movies, restaurants, or books)– which represent many common topics of conversation.

Implicit memory requires little conscious effort and often involves skills or more habitual patterns of behavior. This type of memory shows few declines with age. Many studies assessing implicit memory measure the effects of priming. Priming refers to changes in behavior as a result of frequent or recent experiences. for example, if you were shown pictures of food and asked to rate their appearance and then later were asked to complete words such as s_ _ p, you may be more likely to write “soup” than “soap” or “ship.” The images of food “primed” your memory for words connected to food. Does this type of memory and learning change with age? The answer is typically “no” for most older adults.

Prospective memory refers to remembering things we need to do in the future, such as remembering a doctor’s appointment or to take medication before bedtime. It has been described as “the flip-side of episodic memory”. Episodic memories are the recall of events in our past, while the focus of prospective memories is of events in our future. In general, humans are fairly good at prospective memory if they have little else to do in the meantime. However, when there are competing tasks that also demand our attention, this type of memory rapidly declines. One explanation given for this phenomenon is that this form of memory draws on the central executive of working memory, and when this component of working memory is absorbed in other tasks, our ability to remember to do something else in the future is more likely to slip out of memory.

However, prospective memories are often divided into time-based prospective memories, such as having to remember to do something at a future time, or event-based prospective memories, such as having to remember to do something when a certain event occurs. When age-related declines are found, they are more likely to be time-based, rather than event-based, and in laboratory settings rather than in the real-world, where older adults can show comparable or slightly better prospective memory performance. This should not be surprising given the tendency of older adults to be more selective in where they place their physical, mental, and social energy. Having to remember a doctor’s appointment is of greater concern than remembering to hit the space-bar on a computer every time the word “tiger” is displayed, and outside the lab many more compensatory aids (e.g., post-it notes, calendars, phone alarms) are readily available.

Recall versus Recognition. Memory performance often depends on whether older adults are asked to simply recognize previously learned material or recall material on their own. Generally, for all humans, recognition tasks are easier because they require less cognitive energy. Older adults show roughly equivalent memory to young adults when assessed with a recognition task. However, in recall tasks, older adults show memory deficits in comparison to younger adults. While the effect is initially not that large, starting at age 40 adults begin to show regular age-graded declines in recall memory compared to younger adults.

The Age Advantage. Fewer age differences are observed when memory cues are available, such as for recognition memory tasks, or when individuals can draw upon acquired knowledge or experience. For example, older adults often perform as well if not better than young adults on tests of word knowledge or vocabulary. Expertise often comes with age, and research has pointed to areas where aging experts perform quite well. For example, older typists were found to compensate for age-related declines in speed by looking farther ahead at printed text. Compared to younger players, older chess experts focus on a smaller set of possible moves, leading to greater cognitive efficiency. Accrued knowledge of everyday tasks, such as grocery prices, can also help older adults make better decisions than young adults.

Attention and Problem Solving

Changes in Attention in Late Adulthood. Changes in sensory functioning and speed of processing information in late adulthood often translate into changes in attention. Research has shown that older adults are less able to selectively focus on information while ignoring distractors, although Jefferies and her colleagues found that when given double time, older adults could perform at the same level as young adults. Other studies have also found that older adults have greater difficulty shifting their attention between objects or locations.

Consider the implication of these attentional changes for older adults. How does maintenance or loss of cognitive ability affect older adults’ everyday lives? Researchers have studied cognition in the context of several different everyday activities. One example is driving. Although older adults often have more years of driving experience, cognitive declines related to reaction time or attentional processes may pose limitations under certain circumstances. In contrast, research on interpersonal problem solving suggests that older adults use more effective strategies than younger adults to navigate through social and emotional problems. In the context of work, researchers rarely find that older individuals perform more poorly on the job. Similar to everyday problem solving, older workers may develop more efficient strategies and rely on expertise to compensate for cognitive declines.

Problem Solving. Declines with age are found on problem-solving tasks that require processing non-meaningful information quickly– a kind of task that might be part of a laboratory experiment on mental processes. However, many real-life challenges facing older adults do not rely on speed of processing or making choices on one’s own. Older adults resolve everyday problems by relying on input from others, such as family and friends. They are also less likely than younger adults to delay making decisions on important matters, such as medical care.

What might explain these deficits as we age? The processing speed theory, proposed by Salthouse, suggests that as the nervous system slows with advanced age our ability to process information declines. This slowing of processing speed may explain age differences on a variety of cognitive tasks. For instance, as we age, working memory becomes less efficient. Older adults also need longer time to complete mental tasks or make decisions. Yet, when given sufficient time (to compensate for declines in speed), older adults perform as competently as do young adults. Thus, when speed is not imperative to the task, healthy older adults generally do not show cognitive declines.

In contrast, inhibition theory argues that older adults have difficulty with tasks that require inhibitory functioning, or the ability to focus on certain information while suppressing attention to less pertinent information. Evidence comes from directed forgetting research. In directed forgetting people are asked to forget or ignore some information, but not other information. For example, you might be asked to memorize a list of words but are then told that the researcher made a mistake and gave you the wrong list and asks you to “forget” this list. You are then given a second list to memorize. While most people do well at forgetting the first list, older adults are more likely to recall more words from the “directed-to-forget” list than are younger

Aging stereotypes exaggerate cognitive losses. While there are information processing losses in late adulthood, many argue that research exaggerates normative losses in cognitive functioning during old age. One explanation is that the type of tasks that people are tested on tend to be meaningless. For example, older individuals are not motivated to remember a random list of words in a study, but they are motivated for more meaningful material related to their life, and consequently perform better on those tests. Another reason is that researchers often estimate age declines from age differences found in cross-sectional studies. However, when age comparisons are conducted longitudinally (thus removing cohort differences from age comparisons), the extent of loss is much smaller.

A third possibility is that losses may be due to the disuse of various skills. When older adults are given structured opportunities to practice skills, they perform as well as they had previously. Although diminished speed is especially noteworthy during late adulthood, Schaie found that when the effects of speed are statistically removed, fewer and smaller declines are found in other aspects of an individual’s cognitive performance. In fact, Salthouse and Babcock demonstrated that processing speed accounted for all but 1% of age-related differences in working memory when testing individuals from ages 18 to 82. Finally, it is well established that hearing and vision decline as we age. Longitudinal research has found that deficits in sensory functioning explain age differences in a variety of cognitive abilities. Not surprisingly, more years of education, higher income, and better health care (which go together) are associated with higher levels of cognitive performance and slower cognitive decline.

Beyond Formal Operational Thought: Post-formal Development?

As mentioned previously, according to Piagetian theory, formal operational thought emerges during adolescents. The hallmark of this type of thinking is the ability to think abstractly or to consider possibilities and ideas about circumstances not directly experienced. Thinking abstractly is only one characteristic of adult thought, however. If you compare a 15 year-old with someone in their late 30s, you would probably find that the latter considers not only what is possible, but also what is likely. Why the change? The adult has gained experience and understands that possibilities do not always become realities. They learn to base decisions on what is realistic and practical, not idealistic, and can make adaptive choices. Adults are also not as influenced by what others think.

In addition to moving toward more practical considerations, thinking in adulthood may also become more relativistic, dialectical, and systemic. These advanced ways of thinking are referred to as Postformal Thought. Relativistic thinking refers to the appreciation of multiple perspectives, and the understanding that knowledge depends on the perspective of the knower. In later life, adults are able to continue to entertain multiple perspectives simultaneously, and also at the same time, in the face of all those possibilities, to make a decision, commit to a specific course of action, and carry it out. This suggests that such post-formal thought goes beyond cognition to the integration of thought and action.

Dialectical Thought. Abstract ideas that the adolescent believes in firmly may become standards by which the adult evaluates reality. Adolescents tend to think in dichotomies; ideas are true or false; good or bad; and there is no middle ground. However, with experience, the adult comes to recognize that there is some right and some wrong in each position, some good or some bad in a policy or approach, some truth and some falsity in a particular idea. This ability to appreciate essential paradox and to bring together salient aspects of two opposing viewpoints or positions is referred to as dialectical thought and is considered one of the most advanced aspects of postformal thinking. Such thinking is more realistic because very few positions, ideas, situations, or people are completely right or wrong. So, for example, parents who were considered angels or devils by their adolescent children, to adult children, eventually become just people with strengths and weaknesses, endearing qualities, and faults.

Systemic thinking refers to the capacity to think about entire systems of knowledge or ideas. This way of thinking recognizes the complexity of the world around us, based on the inter-connectedness of multiple subsystems at multiple levels. As you can imagine, such thinking is useful for tackling complex problems, and creating mental models that suggest entry points or levers for solving them. When combined with expertise and experience, these modes of thought can be very powerful. Two good examples of systemic thinking in this class are the notion of meta-theories and the idea of higher-order contexts of development. Both require thinking about complex multi-level systems– like systems of theories and ecological perspectives.

Does everyone reach postformal or even formal operational thought? Formal operational thought involves being able to think abstractly; however, this ability does not apply to all situations or all adults. Formal operational thought is influenced by experience and education. Some adults lead lives in which they are not challenged to think abstractly about their world. Many adults do not receive any formal education and are not taught to think abstractly about situations they have never experienced. Further, many people are not exposed to conceptual tools used to formally analyze hypothetical situations. Those who do think abstractly may be able to do so more easily in some subjects than others. For example, psychology majors may be able to think abstractly about psychology but be unable to use abstract reasoning in physics or chemistry. Abstract reasoning in a particular field requires a knowledge base that no one has in all areas. Consequently, our ability to think abstractly also depends on our experiences.

Intelligence and Wisdom

When looking at scores on traditional intelligence tests, tasks measuring verbal skills show minimal or no age-related declines, while scores on performance tests, which measure solving problems quickly, decline with age. This profile mirrors crystalized and fluid intelligence. As you recall from last chapter, crystallized intelligence encompasses abilities that draw upon experience and knowledge. Measures of crystallized intelligence include vocabulary tests, solving number problems, and understanding texts. Fluid intelligence refers to information processing abilities, such as logical reasoning, remembering lists, spatial ability, and reaction time. Baltes introduced two additional types of intelligence to reflect cognitive changes in aging. Pragmatics of intelligence are cultural exposure to facts and procedures that are maintained as one ages and are similar to crystalized intelligence. Mechanics of intelligence are dependent on brain functioning and decline with age, similar to fluid intelligence. Baltes indicated that pragmatics of intelligence show little decline and typically increase with age whereas mechanics decline steadily, staring at a relatively young age. Additionally, pragmatics of intelligence may compensate for the declines that occur with mechanics of intelligence. In summary, global cognitive declines are not typical as one ages, and individuals typically compensate for some cognitive declines, especially processing speed.

Wisdom has been defined as “expert knowledge in the fundamental pragmatics of life that permits exceptional insight, judgment and advice about complex and uncertain matters”. A wise person is insightful and has knowledge that can be used to overcome obstacles in living. Does aging bring wisdom? While living longer brings experience, it does not always bring wisdom. Paul Baltes and his colleagues suggest that wisdom is rare. In addition, the emergence of wisdom can be seen in late adolescence and young adulthood, with there being few gains in wisdom over the course of adulthood. This would suggest that factors other than age are stronger determinants of wisdom. Occupations and experiences that emphasize others rather than self, along with personality characteristics, such as openness to experience and generativity, are more likely to provide the building blocks of wisdom. Age combined with a certain types of experience and/or personality brings wisdom.

Religion and Spirituality

Grzywacz and Keyes found that in addition to personal health behaviors, such as regular exercise, healthy weight, and not smoking, social behaviors, including involvement in religious-related activities, have been shown to be positively related to optimal health. However, it is not only those who are involved in a specific religion that benefit, but so too do those who identified themselves as being spiritual. According to Greenfield, Vaillant, and Marks religiosity refers to engaging with a formal religious group’s doctrines, values, traditions, and co-members. In contrast, spirituality refers to an individual’s intrapsychic sense of connection with something transcendent (that which exists apart from and not limited by the material universe) and the subsequent feelings of awe, gratitude, compassion, and forgiveness. Research has demonstrated a strong relationship between spirituality and psychological well-being, irrespective of an individual’s religious participation. Additionally, Sawatzky, Ratner, & Chiu found that spirituality was related to a higher quality of life for both individuals and societies.

Based on reports from the 2005 National Survey of Midlife in the United States, Greenfield found that higher levels of spirituality were associated with lower levels of negative affect and higher levels of positive affect, personal growth, purpose in life, positive relationships with others, self-acceptance, environmental mastery, and autonomy. In contrast, formal religious participation was associated with lower levels of autonomy but, among older adults, also with higher levels of purpose in life and personal growth. In summary, it appears that formal religious participation and spirituality relate differently to an individual’s overall psychological well-being.

Age. Older individuals identify religion/spirituality as being more important in their lives than those younger. This age difference has been explained by several factors including the likelihood that religion and spirituality provide opportunities for socialization and social support in later life, and assist older individuals in coping with age-related losses. These age differences may also reflect cohort differences in that older individuals were typically socialized to be more religious and spiritual than those younger.

Gender. In the United States, women report identifying as being more religious and spiritual than men do. According to the Pew Research Center, women in the United States are more likely to say religion is very important in their lives than are men (60% vs. 47%). American women are also more likely than American men to say they pray daily (64% vs. 47%) and attend religious services at least once a week (40% vs. 32%). Theories to explain these gender difference include the notion that women may benefit more from the social-relational aspects of religion/spirituality because social relationships more strongly influence women’s mental health. Additionally, compared to men, women have been socialized more to internalize the behaviors linked with religious values, such as cooperation and nurturance.

Worldwide. To measure the religious beliefs and practices of men and women around the world, the Pew Research Center conducted surveys of the general population in 84 countries between 2008 and 2015. Overall, an estimated 83% of women worldwide identified with a religion compared with 80% of men. This equaled 97 million more women than men identifying with a religion. There were no countries in which men were more religious than women by 2 percentage points or more. Among Christians, women reported higher rates of weekly church attendance and higher rates of daily prayer. In contrast, Muslim women and Muslim men showed similar levels of religiosity, except frequency of attendance at worship services. Because of religious norms, Muslim men worshiped at a mosque more often than Muslim women. Similarly, Jewish men attended synagogue more often than Jewish women. In Orthodox Judaism, communal worship services cannot take place unless a minyan, or quorum of at least 10 Jewish men, is present, thus ensuring that men will have high rates of attendance. Only in Israel, where roughly 22% of all Jewish adults self-identify as Orthodox, did a higher percentage of men than women report engaging in daily prayer.

Chapter 10–Living a Healthy Lifestyle

New studies show that the human species could live up to 150 years with proper dieting and exercising. I will start this chapter with this study, then I will discuss more reasonable lifespan expectations and what you can do to live healthier. I have included diets and exercise in a previous book of mine, “My Life As A Loser: A Never-Ending Battle To Lose Weight.” In this book I discussed dieting and exercise in depth, so I will only touch base on these topics in these following chapters.

Humans Could Live up to 150 Years, New Research Suggests
A study counts blood cells and footsteps to predict a hard limit to our longevity

The chorus of the theme song for the movie Fame, performed by actress Irene Cara, includes the line “I’m gonna live forever.” Cara was, of course, singing about the posthumous longevity that fame can confer. But a literal expression of this hubris resonates in some corners of the world—especially in the technology industry. In Silicon Valley, immortality is sometimes elevated to the status of a corporeal goal. Plenty of big names in big tech have sunk funding into ventures to solve the problem of death as if it were just an upgrade to your smartphone’s operating system.

Yet what if death simply cannot be hacked and longevity will always have a ceiling, no matter what we do? Researchers have now taken on the question of how long we can live if, by some combination of serendipity and genetics, we do not die from cancer, heart disease or getting hit by a bus. They report that when omitting things that usually kill us, our body’s capacity to restore equilibrium to its myriad structural and metabolic systems after disruptions still fades with time. And even if we make it through life with few stressors, this incremental decline sets the maximum life span for humans at somewhere between 120 and 150 years. In the end, if the obvious hazards do not take our lives, this fundamental loss of resilience will do so, the researchers conclude in findings published in May 2021 in Nature Communications.

“They are asking the question of ‘What’s the longest life that could be lived by a human complex system if everything else went really well, and it’s in a stressor-free environment?’” says Heather Whitson, director of the Duke University Center for the Study of Aging and Human Development, who was not involved in the paper. The team’s results point to an underlying “pace of aging” that sets the limits on life span, she says.

For the study, Timothy Pyrkov, a researcher at a Singapore-based company called Gero, and his colleagues looked at this “pace of aging” in three large cohorts in the U.S., the U.K. and Russia. To evaluate deviations from stable health, they assessed changes in blood cell counts and the daily number of steps taken and analyzed them by age groups.

For both blood cell and step counts, the pattern was the same: as age increased, some factor beyond disease drove a predictable and incremental decline in the body’s ability to return blood cells or gait to a stable level after a disruption. When Pyrkov and his colleagues in Moscow and Buffalo, N.Y., used this predictable pace of decline to determine when resilience would disappear entirely, leading to death, they found a range of 120 to 150 years. (In 1997 Jeanne Calment, the oldest person on record to have ever lived, died in France at the age of 122.)

The researchers also found that with age, the body’s response to insults could increasingly range far from a stable normal, requiring more time for recovery. Whitson says that this result makes sense: A healthy young person can produce a rapid physiological response to adjust to fluctuations and restore a personal norm. But in an older person, she says, “everything is just a little bit dampened, a little slower to respond, and you can get overshoots,” such as when an illness brings on big swings in blood pressure.

Measurements such as blood pressure and blood cell counts have a known healthy range, however, Whitson points out, whereas step counts are highly personal. The fact that Pyrkov and his colleagues chose a variable that is so different from blood counts and still discovered the same decline over time may suggest a real pace-of-aging factor in play across different domains.

Study co-author Peter Fedichev, who trained as a physicist and co-founded Gero, says that although most biologists would view blood cell counts and step counts as “pretty different,” the fact that both sources “paint exactly the same future” suggests that this pace-of-aging component is real.

The authors pointed to social factors that reflect the findings. “We observed a steep turn at about the age of 35 to 40 years that was quite surprising,” Pyrkov says. For example, he notes, this period is often a time when an athlete’s sports career ends, “an indication that something in physiology may really be changing at this age.”

The desire to unlock the secrets of immortality has likely been around as long as humans’ awareness of death. But a long life span is not the same as a long health span, says S. Jay Olshansky, a professor of epidemiology and biostatistics at the University of Illinois at Chicago, who was not involved in the work. “The focus shouldn’t be on living longer but on living healthier longer,” he says.

“Death is not the only thing that matters,” Whitson says. “Other things, like quality of life, start mattering more and more as people experience the loss of them.” The death modeled in this study, she says, “is the ultimate lingering death. And the question is: Can we extend life without also extending the proportion of time that people go through a frail state?”

The researchers’ “final conclusion is interesting to see,” Olshansky says. He characterizes it as “Hey, guess what? Treating diseases in the long run is not going to have the effect that you might want it to have. These fundamental biological processes of aging are going to continue.”

The idea of slowing down the aging process has drawn attention, not just from Silicon Valley types who dream about uploading their memories to computers but also from a cadre of researchers who view such interventions as a means to “compress morbidity”—to diminish illness and infirmity at the end of life to extend health span. The question of whether this will have any impact on the fundamental upper limits identified in the Nature Communications paper remains highly speculative. But some studies are being launched—testing the diabetes drug metformin, for example—with the goal of attenuating hallmark indicators of aging.

In this same vein, Fedichev and his team are not discouraged by their estimates of maximum human life span. His view is that their research marks the beginning of a longer journey. “Measuring something is the first step before producing an intervention,” Fedichev says. As he puts it, the next steps, now that the team has measured this independent pace of aging, will be to find ways to “intercept the loss of resilience.”

How To Live A Healthy Life
What if you could transform your life today and start feeling better tomorrow? What if it wasn’t that big of a deal to do so? And what if you didn’t need to spend a fortune to get there either? You know what would also be nice?A healthy lifestyle can help you thrive as you move through your life’s journey. Making healthy choices isn’t always easy – it can be hard to find the time and energy to exercise regularly or prepare healthy meals. However, your efforts will pay off in many ways, and for the rest of your life. If you could transform not just your physical appearance, but also the way you think about yourself and your life. This can seem like an overwhelming commitment at first, but once you break it down and think about it as a holistic process rather than a giant leap, it seems much more achievable. After all, we’re talking about 5 minutes per day. That’s all it takes!

Exercise daily
Be physically active for 30 minutes most days of the week. Break this up into three 10-minute sessions when pressed for time. Healthy movement may include walking, sports, dancing, yoga or running. Exercise is the ultimate way to increase your metabolic rate and burn fat while improving your health and well-being. Whether you choose to go to the gym, run around the block, or climb a tree, the most important thing is to do something. The best part is that even if you aren’t that great at it, doing something will give you a sense of accomplishment and increase your confidence. There’s really no excuse for not being active. All you need is a pair of comfortable shoes and about 30 minutes a day. There are so many benefits to being active, including: Better Sex Increased Energy Improved Mood Improved Mental Health Lower Risk of Heart Disease Increased Immunity Greater Sex Drive Stronger Bones Stronger Muscles

Eat Healthy
Eating healthy is crucial for boosting your metabolism, building strong bones and teeth, and preventing heart disease and many cancers. It’s also essential for maintaining a healthy weight, and for keeping your energy levels up too. It can be difficult to know what to eat, especially when you’re throwing yourself a party. This is why it’s important to have a healthy diet that consists of a variety of fresh produce, wholegrains, lean proteins, and low-fat dairy products. You should also limit your intake of sugary drinks, processed foods, saturated fats, salt, and sugary snacks. There are so many healthy food options that you can choose from, such as: Fresh Fruit Nuts and Seeds Low-Fat Dairy Products Lean Proteins wholegrains (e.

Learn Something New
If you think about it, we’re all in this thing called life for a reason: to learn, grow, and experience new things. There’s no way you’re going to be able to do that if you’re constantly worried about money and your bills. The best way to learn new things and expand your knowledge is by getting inspired by other people and what they’ve achieved. There are so many different ways you can do this. You can watch documentaries, read blogs, attend seminars, or simply listen to what other people have to say. The more you do this, the more you’ll realize how much you don’t know and how much there is still to learn. This will boost your confidence, give you the ability to understand new concepts, and make you feel more optimistic about the future.

Sleep Better
Sleep is essential for regulating hormones and building memory. Not sleeping well can lead to poor diet, fatigue, and a lack of confidence. While it can be difficult to change the number of hours you sleep, it’s much easier to adjust the amount of sleep you get. Try and keep a regular sleep schedule so that your body is conditioned to expect the amount of sleep it needs. You should also try to reduce stress in your life and make sure you’re not eating anything that’s going to keep you up at night. If you’re feeling anxious, try and identify what’s causing it and try to eliminate it from your life. Make sure you have a regular time to relax and take care of yourself, like when you’re sick or when you’re just out of the blue feeling down.

Connect With People
The modern world is incredibly isolating, which isn’t great for your mental health or your relationships. You don’t have to put yourself out there in a big way either. Just make sure you’re grabbing coffee with a friend every now and then, sending a quick text message, or saying hi to someone on the street. Doing this will not only boost your social confidence, but it’ll help you get to know the people around you better. It’ll also help you to make new friends when you move cities or even just when you decide to open up a little more. It’s always good to have a few people in your life that you can connect with, whether it’s a close friend, family member, or even a stranger.

Take a Deep Breath and Relax
Life is happening really quickly. You have to make decisions quickly and try to find time for everything. It can be really easy to get hurried, anxious, or stressed out. This is never going to get you anywhere so try to put the brakes on it. Take a few deep breaths, try and identify what’s stressing you out, and try to work out a way to deal with it. This doesn’t mean that you have to do something that you don’t want to do, but you have to have some kind of plan in place. Then, when you’re feeling rushed and short of time, you can use that plan to help you to calm down. This doesn’t mean you have to let everything get to you. It just means that you have to let yourself have a little more control and that you don’t have to be rushed all the time. You may feel pulled in different directions and experience stress from dealing with work, family and other matters, leaving little time for yourself. Learning to balance your life with some time for yourself will pay off with big benefits – a healthy outlook and better health.

Steps you can take:
-Stay in touch with family and friends.

-Be involved in your community.

-Maintain a positive attitude and do things that make you happy.

-Keep your curiosity alive. Lifelong learning is beneficial to your health.

-Healthy intimacy takes all forms but is always free of coercion.

-Learn to recognize and manage stress in your life. Signs of stress include trouble sleeping, frequent headaches and stomach problems; being angry a lot; and turning to food, drugs and alcohol to relieve stress.

Good ways to deal with stress include regular exercise, healthy eating habits, and relaxation exercises such as deep breathing or meditation. Talking to trusted family members and friends can help a lot. Some women find that interacting with their faith community is helpful in times of stress.

-Get enough sleep and rest – adults need around eight hours of sleep a night.

-Talk to your health care provider if you feel depressed for more than a few days. Depression is a treatable illness. Signs of depression include feeling empty and sad, crying a lot, loss of interest in life, and thoughts of death or suicide. If you or someone you know has thoughts of suicide, get help right away. Call 911, a local crisis center or (800) SUICIDE.

Stay Positive
Finally, it’s important to remember that you’re not going to get anywhere if you’re not having fun. If you’re feeling down, try and find the funny side of things and try to look at it from a different perspective. This doesn’t mean that you shouldn’t take things seriously and work hard, but try and find a happy medium. It can be really easy to get trapped in a negative spiral where you’re constantly worrying about the things that are stressing you out. You have to find a way to anchor yourself and stop that spiral from continuing. There are many ways you can do this, like writing them down, visualizing them, or talking to a friend or family member. There are many different ways you can anchor yourself and stop the negative spiral from continuing. This will help you to stay positive, optimistic, and relaxed while you’re navigating life’s challenges.

Avoid injury by wearing seatbelts and bike helmets, using smoke and carbon monoxide detectors in the home, and using street smarts when walking alone. If you own a gun, recognize the dangers of having a gun in your home. Use safety precautions at all times.

Don’t smoke, and quit if you do. Ask your health care provider for help. UCSF offers a smoking cessation program.

If you drink alcohol, drink in moderation. Never drink before or when driving, or when pregnant.

Ask someone you trust for help if you think you might be addicted to drugs or alcohol.

Help prevent sexually transmitted infections (STIs) and HIV/AIDS by using condoms every time you have sexual contact. Keep in mind, condoms are not 100 percent foolproof, so discuss STI screening with your provider. Birth control methods other than condoms, such as pills and implants, won’t protect you from STIs or HIV.

Brush your teeth after meals with a soft or medium bristled toothbrush. Also brush after drinking, before going to bed. Use dental floss daily.

Stay out of the sun, especially between 10 a.m. and 3 p.m. when the sun’s harmful rays are strongest. Don’t think you are safe if it is cloudy or if you are in the water, as harmful rays pass through both. Use a broad spectrum sunscreen that guards against both UVA and UVB rays, with a sun protection factor (SPF) of 15 or higher. Select sunglasses that block 99 to 100 percent of the sun’s rays.

References
scientificamerican.com, “Humans Could Live up to 150 Years, New Research Suggests: A study counts blood cells and footsteps to predict a hard limit to our longevity.” By Emily Willingham; newfifevisionfoundation.org, “How To Live A Healthy Life In The Modern Age.”; ucsfhealth.org, “ Healthy Lifestyles, Healthy Outlook.”;

Chapter 11–An Apple a Day Will Keep the Doctor Away

In the previous chapter I briefly mentioned utilizing a proper diet as a means to improve your life. In this chapter I will spend more time discussing what your diet can do for you.

Healthy Longevity
Longevity is the achievement of a long life. We may hope for longevity so that we can experience many years of quality time with loved ones or have time to explore the world. But living to a ripe old age doesn’t necessarily mean healthy or happy longevity if it is burdened by disability or disease. The population of people over age 65 has grown more quickly than other age groups due to longer life spans and declining birth rates, and yet people are living more years in poor health. Therefore, we will explore not just one’s lifespan but healthspan, which promotes more healthy years of life.

What you do today can transform your healthspan or how you age in the future. Although starting early is ideal, it’s never too late to reap benefits.

Five Key Lifestyle Factors
Researchers from Harvard University looked at factors that might increase the chances of a longer life. Using data collected from men and women from the Nurses’ Health Study and Health Professionals Follow-up Study who were followed for up to 34 years, researchers identified five low-risk lifestyle factors: healthy diet, regular exercise (at least 30 minutes daily of moderate to vigorous activity), healthy weight (as defined by a body mass index of 18.5-24.9), no smoking, and moderate alcohol intake (up to 1 drink daily for women, and up to 2 daily for men). Compared with those who did not incorporate any of these lifestyle factors, those with all five factors lived up to 14 years longer.

In a follow-up study, the researchers found that those factors might contribute to not just a longer but also a healthier life. They saw that women at age 50 who practiced four or five of the healthy habits listed above lived about 34 more years free of diabetes, cardiovascular diseases, and cancer, compared with 24 more disease-free years in women who practiced none of these healthy habits. Men practicing four or five healthy habits at age 50 lived about 31 years free of chronic disease, compared with 24 years among men who practiced none. Men who were current heavy smokers, and men and women with obesity, had the lowest disease-free life expectancy.

Five factors for a longer and healthier lifespan

1. Healthy diet – The prevalence of hypertension (high blood pressure) and dementia increases with age. Eating patterns such as those from the DASH, MIND, and Mediterranean diets can lower the risk of these and other chronic conditions that accompany older ages.
2. Regular exercise – Regular physical activity lowers the risk of several chronic conditions that increase with age including heart disease, hypertension, diabetes, osteoporosis, certain cancers, and cognitive decline. Exercise also helps to lower anxiety and blood pressure, and improve sleep quality. The Physical Activity Guidelines for Americans from the U.S. Department of Health and Human Services first recommends to move more and sit less, with some activity better than none. For additional health benefits, they advise a minimum of 150-300 minutes weekly of moderate to vigorous activity, like brisk walking or fast dancing, as well as two days a week of muscle-strengthening exercises. Older adults who are at risk for falls may also wish to include balance training such as tai chi or yoga. See additional physical activity considerations for older adults.
3. Healthy weight – Determining one’s healthy weight range is unique for each person. Factors to consider include reviewing current health conditions, family history, weight history, and genetically inherited body type. Rather than focusing on scale weight alone, monitoring an increase in harmful visceral “belly fat” and weight change since age 20 may be useful.
4. Not smoking – Smoking is a strong risk factor for cancer, diabetes, cardiovascular disease, lung diseases, and earlier death as it promotes chronic inflammation and oxidative stress (a condition that can damage cells and tissues). Smoking harms nearly every organ of the body. Quitting greatly reduces the risk of these smoking-related diseases.
5. Moderate alcohol – Research finds that moderate drinking, defined as 1 drink daily for women and 2 drinks daily for men, is associated with lower risk of type 2 diabetes, heart attacks, and early death from cardiovascular disease. Low to moderate amounts of alcohol raises levels of “good” cholesterol or high-density lipoprotein (HDL) and prevent small blood clots that can block arteries. However, because alcohol intake—especially heavier drinking—is also associated with risks of addiction, liver disease, and several types of cancer, it is a complex issue that is best discussed with your physician to weigh your personal risk versus benefit.

Additional Factors for Healthy Longevity
Beyond the five core lifestyle habits mentioned above, a growing body of research is identifying additional factors that may be key to increasing our healthspans:

-Having life purpose/meaning. Research shows that having a sense of meaning or purpose in daily life is associated with better sleep, healthier weight, higher physical activity levels, and lower inflammation in some people. It also promotes optimism. If people are healthier at older ages, they can potentially contribute more to their family, community, and society as a whole. This translates to being stronger and more mobile to assist younger generations with childcare or other family activities, working beyond retirement age, volunteering for local causes, pursuing pleasurable hobbies, and engaging in community groups. In reciprocation of these activities, people reap a sense of meaning and purpose.

-Social connections. Studies of adults 50 years and older show that loneliness and social isolation are associated with a higher risk of disease, disability, and mortality. The U.S. Health and Retirement study comprised of 11,302 older participants found that almost 20% met criteria for loneliness. Those who experienced persistent loneliness had a 57% increased risk of early death compared with those who never experienced loneliness; those who were socially isolated had a 28% increased risk. Participants who experienced both loneliness and social isolation showed signs of advanced biological aging (e.g., chronic inflammation that can increase the risk of morbidities). Conversely, people experiencing cognitive decline may have less social contact due to greater difficulty initiating and maintaining social interactions.

-Brain stimulation. Stressing the brain or doing activities that entail strenuous mental effort, such as learning a new skill, language, or exercise format during leisure time may reduce the risk of cognitive decline. Research has shown a strong association of attaining higher education and engaging in work that is intellectually demanding with a lower risk of dementia, Alzheimer’s disease, and cognitive impairment.

-Improving sleep quality. Research is still inconclusive, but some reports suggest that insomnia is associated with higher rates of Alzheimer’s disease (AD) and other forms of cognitive decline. Chronic disrupted sleep may lead to systemic (throughout the body) inflammation, which is a precursor to the development of beta-amyloid plaques in the brain as found with AD. The reverse can also occur with advanced stages of AD causing disturbed circadian rhythms that regulate sleep. However, a cohort study of 1,629 adults aged 48 to 91 years from the Alzheimer’s Disease Neuroimaging Initiative did not find that sleep disturbance affected cognitive decline in later years.

-Intermittent fasting. Animal research shows that caloric restriction over a lifetime, such as with intermittent fasting, increases lifespan. The body responds to fasting with improved regulation of blood glucose, greater stress resistance, and decreased inflammation and production of damaging free radicals. During fasting, cells remove or repair damaged molecules. These effects may prevent the development of chronic disorders including obesity, diabetes, cardiovascular disease, cancer, and neurological decline including Alzheimer’s disease. Other effects of intermittent fasting in animals include better balance and coordination, and improved cognition, specifically with memory. Human studies have found improved insulin sensitivity, lower blood pressure, decreased LDL cholesterol, and weight loss. However, human studies and randomized controlled trials on the effects of fasting on aging and longevity are still needed.

How sensory changes with aging affect how we eat
We know that taste is key when enjoying a meal, but what about the smell, texture, appearance, colorfulness, mouthfeel, and even the sound of food (how it crunches in the mouth or sizzles when cooking)? These are the human senses that contribute to the eating experience and influence our food choices.

These senses can decline over time for various reasons: normal aging, which causes a gradual decrease in taste and smell; prescription drugs that reduce taste sensitivity and promote dry mouth or lack of saliva; deficiencies in micronutrients such as zinc that reduce taste; and poor dentition with tooth loss or dentures leading to chewing problems. Up to 60% of adults 70 years and older may lose their sense of taste. With this loss may come heavier seasoning of food with sugar and salt. They may prefer softer lower-fiber foods that don’t require much chewing. Poor taste and smell in the elderly is associated with lower dietary quality and poorer appetite.

Food aromas are important as they trigger the release of saliva, stomach acid, and enzymes in preparation for digestion. The scent of food can trigger the release of dopamine and serotonin, causing a feeling of wellbeing to encourage eating. An impaired sense of smell in older adults is also associated with less variety in food choices and poorer nutrition, but can also lead to increased food intake and weight gain in some individuals.

Seasoning food more liberally with sodium-free herbs, spices, and vinegars may help to compensate for sensory deficiencies. Using foods with a savory umami quality like mushrooms, tomatoes, some cheeses, and yeast can boost richness and flavor. Another sensory aspect of food called “kokumi” describes a full and rich mouth feel—such as that experienced from a minestrone soup, an aged cheese, or a seafood stew simmering for many hours. If poor appetite from sensory loss is a problem, providing variety through different textures, smells, and colors in the meal may stimulate an increased desire to eat.

Eating and food preparation are also important activities offering socialization and mental stimulation such as when learning new cooking skills. Preparing meals helps to reduce sedentariness as there are several action steps involved: selecting and purchasing, washing and chopping, and cooking the ingredients.

Looking Ahead
Identifying additional factors that improve and extend our healthspans is an active area of scientific inquiry. In the meantime, current research findings are encouraging, and underscore the importance of following healthy lifestyle habits throughout one’s life course. That said, sticking to these behaviors is easier said than done, and public policies must support and promote these habits by improving the food and physical environments that surround us.

Diet is obviously a major health factor, but quantifying its impact is not easy. Since it is all but impossible to conduct a controlled study of how a particular type of food affects health in the long run, scientists have to resort to population studies, which are plagued by the abundance of confounding factors. On the other hand, the sheer number of dietary population studies might offset their imperfections. When dozens or studies and meta-analyses point in one direction, we should probably pay attention.

Meta-meta-analysis
This new study uses numerous meta-analyses, plus data from the vast Global Burden of Disease (GBD) study completed in 2019, to estimate the impact of various dietary changes on human lifespan.

First, the researchers established a typical “Western diet”, based on the same population studies, and then built a model that estimates the effect of various changes to this diet that are started at the age of 20, 60, or 80. According to the model, if you are a 20-year-old woman, the increase in whole grain consumption from 50 grams (baseline Western diet) to 225 grams a day extends your life expectancy by two years. An increase in legume consumption from 0 to 200 grams a day results in an even more substantial 2.2-year extension, and boosting the consumption of nuts from 0 to just 25 grams a day gives you an additional 1.7 years of life; of course, extremely few people consume exactly zero legumes and nuts.

There are also gains to be made from decreasing the consumption of certain foods, including red meat and processed meat, which have been consistently reported to be harmful. Under this model, reducing consumption from average Western levels (100 grams and 50 grams a day, respectively) to zero gives 1.6 additional years of life. On the other hand, increasing daily consumption of fish from 50 to 200 grams increases lifespan by 0.5 years. Large gains can also be achieved by cutting back on refined grains, sugary beverages, and eggs. Milk and white meat have little effect on lifespan.

Eating more fruits and vegetables is a good idea as well, but the gains are smaller, since the researchers calculated relatively high baseline amounts. Eating more fruit (400 grams instead of 200 grams a day) increases lifespan by 0.4 years, and more vegetables (400 grams instead of 250 grams) by 0.3 years. The results for men closely resemble those for women but are slightly more pronounced.

Overall, the researchers estimate that by following what they call “the optimized diet”, a 20-year-old woman can increase her life expectancy by 10.7 years, and a 20-year-old man can increase his by 13 years. If started at 60 years of age, the optimized diet supposedly increases lifespan by 8 and 8.8 years, respectively, and if started at 80, both sexes would benefit from a 3.4-year increase. The researchers also devised “the feasible diet”, which achieves considerable lifespan extension via less drastic changes.

Taken at face value, these results position healthy diet as the best geroprotective intervention available today. The researchers took an additional step and developed an online tool that helps calculate gains in lifespan you can achieve by making specific dietary changes. Here are the gains in lifespan for 20-year-old women (left) and men.

Better late than never
The results look rosy, but they are based on population studies, a specific methodology, and assumptions that may or may not be correct. For instance, the researchers assume that “the time to full effect”, which represents the start of a dietary change until it stops adding years to lifespan, is 10 years. While this assumption is based on the available data, the authors admit they might be wrong.

On the other hand, the study sits well with previous research. Interestingly, scientists are slowly finding biological evidence that backs some (but not all) dietary populational studies. As an example, recently, a genetic mutational signature was found that firmly links both processed and unprocessed red meat to colorectal cancer – something that population studies have been suggesting for a long time.

Another major takeaway from the study is that while it is better to start eating healthy as early as possible, it is also never too late, with gains in lifespan remaining very substantial even for 60-year-olds.

Conclusion
This study is probably the first ever to propose a model that calculates gains in lifespan from several dietary interventions, an intriguing undertaking that might become a basis for future research.

Another new study offers an online calculator that estimates how changing your eating habits can shift life expectancy.

A young adult who switches from a typical Western diet to a plant-based eating pattern—one that also lowers risk of the most common cancers, packed with whole grains, legumes, and plant foods, and less red and processed meat—can add more than a decade to their life, finds a new study.

Those same dietary changes made by an 80 year old would also increase their life expectancy by multiple years. And even smaller shifts to a healthier diet made by people of all ages could add years of life.

The study was published in PLOS Medicine.

The paper’s estimates are based on population data and not intended for individual forecasting, but they place a clear and dramatic figure on the importance of diet for good health. AICR research shows that a plant-based diet plays a key role in reducing the risk of cancer, one of the leading causes of death in the U.S.

The study’s findings are translated into an online Food4HealthyLife calculator where users can input eating habits—both before and after that healthier change—and see the estimated shift in life expectancy. (As with the study, the estimates are applicable to populations, not as a personal outcome.)

Whole grains and an optimal diet for longer life
For the estimates, the paper used data from a 2019 Global Burden of Disease study to build a model that predicted how various food groups could affect life expectancy. This paper, which included AICR evidence to reach their conclusions on cancer, found that unhealthy diets lead to 11 million deaths annually.

The authors of the new study compared the typical Western diet to what they called the optimal diet, based on the analyses. The optimal diet was higher in whole grains, legumes, fish, fruits and vegetables, and included a handful of nuts, while reducing red and processed meat, sugar-sweetened beverages and refined grains, compared to the Western diet.

The paper also calculated life expectancy based on food choices in-between the optimal and Western diet, what the authors call a feasibility approach.

For 20 years olds in the United States, the model estimates that a continued change from a typical Western to optimal diet would extend women’s lives by close to 11 years and men’s by 13 years.

The largest life expectancy gains would be made by eating more legumes, whole grains and nuts, and less red and processed meat.

Changing from a typical to the optimal diet at age 60 could add an estimated 8 years to life for women and almost 9 for men; 80 year olds could gain 3.4 years from such dietary changes. Moving to an eating pattern that was half of the optimal—the feasibility approach—also led to significant gains in life expectancy among people of all ages. For example, a 40 year old who shifted from a Western pattern of eating to a feasibility diet could gain approximately another 6 years of life; an 80 year old could gain another 2 years.

Lower cancer risk and chronic disease
The optimal diet in this study aligns with AICR’s dietary recommendations for lowering cancer risk. Strong research shows that eating more whole grains and fiber specifically along with less red and processed meat lowers risk of colorectal cancer. Beans, fruits, vegetables and a healthy eating pattern in general will give you fiber, nutrients and phytochemicals that may help prevent cancer, and manage your weight. AICR also recommends cutting back on sugary drinks and processed foods high in sugar, fat and starches, which will also help with weight control.

Staying a healthy weight is one of the most important lifestyle steps adults can take to reduce the risk of the most common cancers.

This same pattern of healthy eating is also linked to lowering risk of having obesity and diabetes, two chronic diseases linked to increased cancer risk. This plant-forward diet can also reduce the risk of heart disease and other chronic diseases throughout all stages of a person’s life, according to the Dietary Guidelines.

This recent study uses a modeling approach, and there are limitations to its findings. The study is based on previous analyses, which have their own caveats. The estimates do not account for differences in a population’s specific risk factors or genetic risks. The time for dietary change to have an affect was also uncertain, as previous research has varied. Here, the study assumed it would take 10 years to achieve full effects.

Yet as the authors conclude: Even the most conservative approaches indicate strong effects in increasing life expectancy due to dietary changes.

References
hsph.harvard.edu, “Healthy Longevity.”; lifespan.io, “‘The Perfect Diet’ May Increase Lifespan by 13 Years: This analysis is built from many population studies.” By Arkadi Mazin; aicr.org, “Eating Healthy Can Extend Life by a Decade—and Also Lower Cancer Risk.” By Mya Nelson;

Chapter 12–The Importance of Companionship in the Elderly

The need for companionship is strong in the elderly population and finding ways to provide social interactions can greatly benefit them.

The feeling of loneliness is a common human feeling that you or maybe someone you love experiences. While the need for companionship may take different forms in different stages of life, it doesn’t diminish as you age.

However, for elderly populations, access to companionship can be limited by several factors from leaving the workplace to decreased physical mobility. That’s why caretakers need to take the time to consider the benefits of companionship in elderly populations.

Elderly adults require interaction with other people to maintain their emotional and mental well-being. Those in this age group may increase their lifespan through regular companionship due to the positive benefits of frequent and meaningful engagement with others—whether that is with family, friends, neighbors, healthcare professionals, or volunteers.

Effects of isolation
Loneliness and isolation are growing issues among the elderly that may take a toll on health and wellbeing. Tulane University reported several effects of social isolation, including:
-Lower immune function
-Higher rates of anxiety and depression
-Suicidal ideation and thoughts
-Decreased cardiovascular health
-Poor cognitive function

A study published in the Journals of Gerontology noted that loneliness is associated with a 40% increase in the risk of dementia.

Factors behind social isolation
Members of the elderly population often deal with isolation because they are frequently living alone after the passing of a spouse or after their adult children move away. Some move into care facilities where they require additional care but may struggle to interact with people they don’t know in the facility.

Social gatherings tend to become less frequent as people have other responsibilities and commitments, and retired individuals no longer experience the social interactions they once had in the workplace.

Additionally, the National Institute on Aging reports that one in three people between the ages of 65 and 74 experiences hearing loss. After the age of 75, the number of people with hearing loss increases to nearly one in two. Hearing loss can make it difficult to participate in social situations, leading to an increased feeling of isolation.

Tips for caretakers
If you care for an elderly adult, follow these tips to strengthen your relationship and help to ensure that they feel supported in this stage of life:
-Communicate openly
-Set a schedule to visit frequently
-Find a shared hobby and do it together
-Ask about things they’re interested in and make conversation
-Facilitate other social opportunities, such as participation in community events or activities or interactions with friends or family members
-Use technology to increase interactions, such as helping them make phone calls to or video chat with loved ones who may not be able to visit in person
-Understand their goals and desires and look for ways to help them achieve these goals
-Be sensitive to their needs, such as struggles with dementia or other mind-altering conditions that might make it difficult to interact with new people

Understanding the importance of companionship for seniors is important for people in every stage of life. Those in the elderly stage might struggle to make friends or form connections but having new opportunities to do so can make a big difference.

Those caring for the older population can take steps to build relationships with their loved ones and help them to feel supported and valued. With the right approach, seniors can be made to feel less isolated through companionship efforts and initiatives.

“I have learned that to be with those I like is enough.” -Walt Whitman
A strange and damaging tendency present in both individuals and societies is the assumption that because something is a certain way, and has been for a long time, it should be. That allows us to accept all manner of injustices and to keep in place ideas that have long since been disproven.

One example of that is the idea of loneliness in older adults. We almost take it for granted that as our loved ones or ourselves age they’ll get more isolated. They’ll have fewer friends. The ones they have will move or take ill or die, and their social circle will cinch up.

The problem is that because we assume these things to be true, we don’t take action when they come to pass. And then the cycle is perpetuated until we believe that isolation is a natural part of aging. It isn’t. It is neither inevitable nor good. Companionship for seniors is incredibly important, as important as it is for anyone at any stage of their lives. It promotes better mental health, better physical health, creates new routines, and really, just makes life better.

Cultivating new friendships while maintaining old ones might echo the Girl Scout motto, but it is good for all older adults. Don’t believe that growing old means being alone. Life is still a vibrant journey, and friendships can continue to bring happiness.

Why Companionship Is Important For Older Adults
When you think about it, it is deeply weird that we accept loneliness as a natural part of getting old, like it is a medical condition. And it is deeply weird that we rationalize that because it is normal, it must be ok. There is no other time in life when we feel that way. No one says, “It’s good for a 22-year-old to be alone; that’s just the way it is!”

An older adult is no different than the 22-year-old. They might act as if, and even convince themselves to believe that, being alone is ok, because they have internalized the idea, but that is rarely the case. Yes, of course, there are some seniors who do genuinely prefer being alone, or who want to retire away with their books, just as there are people at every age who prefer solitude. And, if genuine, it is something to respect. But you shouldn’t just assume that stoicism implies acceptance and happiness.

Because, the truth is, for most people, a lack of companionship isn’t just sad, it is downright dangerous. Seniors facing isolation are at a higher risk of depression, which, as it sets in, can lead to more isolation and increase depression severity. All too often this can lead to suicidal thoughts and even actions. That’s why we have the Friendship Line: so seniors know there is someone to talk to. Someone who cares.

There are also physical considerations, the most obvious one being that isolation means it is harder to get help when something goes wrong. If a person falls or has a stroke, who knows how long it could be before they get help. This problem has slightly decreased with the rise of mobile phones, but not everyone has them on them at all times, and you might be rendered unable to use them.

So yes: isolation can be bad. But socialization isn’t like taking medicine; it isn’t just about fighting away symptoms. Companionship does more than drive away negative outcomes. It creates positive ones.

The Benefits Of Companionship For Older Adults
Breaking free from isolation has many mental health benefits. The brain thrives on activity and stimulation, and withers without it.

Think about it. After retiring, possibly losing a spouse or partner, and having social gatherings disappear, a person can lack the social stimulation that comes with work, with events, and with unexpected happenstances and unforeseen social engagements. Even the most routine workday is a maze of interpersonal relationships. How do you talk to Jan about your weekend, how do you talk to your boss about his mistake, how do you ask for help from a basic stranger in Accounting? All of that is mental effort, and forces you to use the imaginative power of empathy. When you are alone, that goes away.

So seeing other people, whether that is at a spin class, a yoga seminar, computer lessons, or just a regular lunch, forces the brain to be active. It creates new patterns in the week and new responsibilities. It creates new social engagements. It can make you try new things. And that’s always healthy. Making the brain work doesn’t just fend off dementia and Alzheimer’s. It makes it stronger and more flexible, helping you continue a lifetime of learning. Making plans and figuring out activities keeps the brain strong, like working out. And the more social engagements you have, the more likely you are to take care of yourself and maintain proper hygiene, a clean home, maybe plants for when friends drop by. That has been shown to fight off depression.

Social activities have another added benefit: it lets you feel cared for and supported. You are not just practicing empathy; others are practicing it toward you. You are being seen as another person, and not just a lingering shadow. The other side of that is that you are caring and supporting other people as well. You’re giving them that gift, just as you are getting it. Both sides of this are important for people to feel valued, safe, and filled with purpose.

Socialization, of course, often involves physical activity as well. When you are moving, you are getting exercise, even when exercise isn’t your intent. Just the act of getting up and doing things can make you stronger, which boosts the immune system and helps prevent osteoporosis.

How Loneliness Affects Your Physical Health
If you’ve experienced ongoing feelings of loneliness, it can have negative effects on your physical health. It could lead to weight gain, sleep deprivation, poor heart health, and a weakened immune system. Loneliness can also put your body under more stress than normal. An increased amount of stress can increase blood pressure and affect your memory and problem-solving skills.

Ways to Combat Loneliness
Making personal connections is key to combatting feelings of loneliness. It’s always a good idea to check in with your own feelings and discuss them with others. Again, it’s not a matter of how many friends you have, but the presence of close relationships. Having good relationships will improve your mood and create an opportunity to meet people with same interests. Regular exercise is one of the best things you can do for your overall health. Start a regular exercise regime and fuel your body with nutritious foods. Eating to take care of your body and getting adequate sleep is essential to improving and maintaining your mental and physical health.

Loneliness and social isolation are significant public health crises in older adults. The issues about companionship have many psychosocial and cultural. In modern-day India, there is a significant increase in the number of older adults left to live alone because of sociocultural changes in our society. Companionship in late life is known to promote the quality of life and decrease the mental health morbidity. There is an increasing role of pets as companions to the elderly. Novel technologies such as artificial intelligence in the form of robots are being explored to support the elderly. Sexuality is another complex issue related to older adults that is often ignored. The sexuality and sexual functioning in older adults largely depend on physiological, psychological, and sociocultural factors. The principles of ageism have influenced sexuality in older adults. Sociocultural issues and the aging-related pathophysiological changes can contribute to an increased risk for legal issues related to sexuality in this population. There is a need for more systematic research into the multifaceted concept of companionship and sexuality in the older adult population. This review article addresses these two distinct subjects separately.

Companionship Issues in the Aging Population
Definitions and Concepts

Loneliness is an unpleasant and distressing phenomenon resulting from inconsistency between individuals’ desired level of social relations and the real level of connections. Social isolation is an objective state of having a few social relationships or infrequent social contact with others. Loneliness and social isolation are becoming significant public health issues affecting older adults’ mental health globally.

Companionship is defined as “social involvement in shared activities, recreational or nonrecreational, that is pursued for the intrinsic goal of satisfaction or enjoyment.” Unlike social support, companionship aims not to solve a problem or provide aid, but to experience pleasure.

Prevalence of Older Adults Living Alone in India
The National Family Health Survey data waves from 1992–1993 and 2005–2006 show the change in India’s living arrangement structure. The proportion of elders living alone or only with their spouses (thus independently of their children) increased from 9% to 10%. According to the recent Longitudinal Ageing Study in India (LASI) wave-1 report, the prevalence of older adults living alone was 5.9%. It was also interesting to find that only 14.4% are staying with spouses and children as per the LASI report. As per the United Nations’ report in 2017, the proportion of older adults living alone is greater in Europe, Northern America, Australia, and New Zealand as compared to Asian, African, and South American countries.

Factors Contributing to Isolation
The traditional Indian society had many protective factors such as joint family systems with children staying together with parents and supporting in their late life. The elderly population living in rural areas had better social networks and certain rituals and customs that promote family unions. All these factors were helping in maintaining adequate social networks and connectedness among older adults in India. However, with modernization, especially in the last two decades, there is a dramatic change in every walk of life. In the modern-day world, the demographic and sociocultural changes such as urbanization, migration, the emergence of nuclear families, empty nests, increased life expectancy, increased widowhood status, generation gap in the digital literacy, and increased institutionalization of older adults might contribute to social isolation and loneliness in older adults in India. In addition, disasters such as the COVID-19 pandemic have pushed millions of older adults in our country to an objective state of social isolation and loneliness.

Perceived Need for Companionship in Older Adults
In later life, spouses serve as the primary and most proximate companions, followed by friends and neighbors. A study has shown that neighborhood social cohesion did not significantly predict the perceived companionship of individuals residing with others. This might be one of the reasons for the individuals to remarry at old age for a source of companionship. The geriatric population, by their loss, changes in their social and family roles, physical and psychological vulnerabilities, and cognitive decline, will need companions in one or the other form for the support. In a qualitative study by Morgan et al., it was found that loneliness manifests in older adults as physical pain, which would explain the difficulties they had in articulating such experiences. The neighborhood social cohesion predicts perceived companionship for older adults, particularly for those who are living alone.

Effects of Loneliness and Isolation on Physical and Mental Health
Loneliness and isolation have been linked to poor physical health, increased risk for modifiable diseases such as diabetes mellitus, hypertension, cardiac illnesses, metabolic syndrome, and increased mortality. These may be directly related to loneliness or indirectly associated with it because of the various adverse health behaviors such as excessive alcohol intake, smoking, and reduced physical activity, which are more prevalent in the socially isolated elderly population. These people are also at risk for depression, anxiety, and cognitive decline. Studies have found that there is a reciprocal relationship between loneliness and depression. Older individuals living alone are at an increased risk for faster cognitive decline.

Companionship and friendship may act as a resource that buffers against the losses associated with old age and helps uplift the person’s self-esteem. The formation of new companionship after a loss is dependent on the personality traits of both persons, degree of attraction toward each other, financial and social status of companion, and perceived need for companionship. Higher level of negative affect and lower level of companionship and friendship intimacy predict greater substance use. The factors such as intimacy in the relationships and drug abuse in the companions predict the substance use in the general adult population which may be applicable to geriatric population as well. It has been found that mealtime interactions were significantly positively related to older adults’ life satisfaction.

Promoting Companionship in Late Life
There is a need for sociocultural changes that recognize the value of companionship in late life. Ageism is an important barrier that prevents any change in this attitude toward the companionship of the elderly in their late life. Daycare centers for active aging, assisted living communities for senior citizens, peer support interventions, and psychosocial support through the contact of volunteers in person or through telephone are some of the interventions that are being explored for promoting companionship in late life. Training of family and professional caregivers needs to be explored to facilitate the improvement in the quality of engagement in order to promote appropriate companionship in addition to the focus on assisting with basic daily activities. Recognition of the importance of such services has encouraged a few home care agencies to include this in the range of services offered to the elderly. The various interventions at individual, community, and society levels such as personal contact, activity and discussion groups, animal contact, skills training (social skills training, digital literacy, etc.), service delivery programs, model of care (spontaneous, resident-driven, purposeful interaction with plants, animals, and children), reminiscence activities, support groups, and public broadcast systems have been found to have a beneficial role in promoting companionship in older adults. There is a need to ensure optimal safety precautions to prevent any exploitation or abuse of the elderly receiving the services to promote companionship.

Role of Pets (Companion Animals), Humanoid Robots, and Technology
In a systematic review, it has been found that animal companionship was largely effective in improving the health of older adults, including both physical and mental health as well as the quality of life. With respect to mental health, involvement with a peer companion and a companion animal improved the patient’s quality of life and had a positive impact on symptoms of depression, anxiety, cognitive impairment, and behavioral and psychological symptoms of dementia. It has been proposed for reducing the adverse health outcomes wrought by social isolation and loneliness by deploying robots to function as social companions and friends to socially isolated elderly people in the pandemic period. The other modes include social media, online-based video/audio conversation, voice-controlled intelligent personal assistants, avatar models, and other virtual agents. These interventions are explored as potential solutions in countries with scarcity of human resources because of the decline in the population of younger adults.

Paradoxical Aspects of Companionship
Paradoxically, the counterintuitive nature of the relationship between a patient and a companion complicated by the negative expressed emotions and caregiver burden may lead to an increased likelihood of poor mental health of elderly persons (“care paradox”). Companions of older adults may have sleep disturbances themselves, which leads to the reduced quality of life in them, which further has implications in the future care for the elderly. Too little or too many interactions with a companion can have a negative outcome in anxiety symptoms of the elderly, which was explained by the hypothesis that, “as the cognitive functions in older adults decline, their dependency increases, which causes increased anxiety toward the companion.”

Further research is required regarding safety, mobility issues, confidentiality, and resources concerning new companions. It is important to study multifaceted constructs of companionship and living arrangements and impactful and appropriate use of technology that facilitate companionship and social interactions.

Sexual Issues and Sexuality in the Aging Population
The term “sexuality” includes various aspects of a person’s sexual functioning such as orientation, gender identity, eroticism, intimacy, pleasure, and reproduction. Sexuality is an essential part of any human being, and the expression of it is a basic human need and right. There has been a significant increase in research in sexuality and sexual problems in the aging population because of various reasons such as increased life expectancy and increased media coverage.

Similar to their younger counterparts, the old age population has normal variations in their sexuality. It is not always possible to decipher the normal age-related changes in the elderly from those related to illness and psychosocial issues.

An Overview on Studies in Sexuality in the Aging Population
The studies done across the regions have found the following observations. Studies found that there is no abrupt decline in sexuality in old age; rather, it is gradual. Contrary to a popular belief, it was found that the majority of older adults are sexually active, and even in extreme old age, sexual activity does not disappear. The decline in sexuality in old age could be related to physiological and psychological factors, reduced availability of partners, and preoccupation with the social norms. Sexuality is considered a biological essence. Sexual activity among old age females heavily depends on societal norms, attitudes, and availability of functionally capable and socially sanctioned male partners. Loss of a partner is more common and disturbing in women than men. For men, sleep, mental health, and attitudes toward sex are associated with late-life sexuality. For women, the important factors are having a comparatively younger husband, anxiety levels, mental health, marital satisfaction, experience on sexual intercourse, and attitudes toward sex. Homosexual relationships

toward sex. Homosexual relationships and self-stimulatory practices are more common in men.

There is certain heterogeneity and limitations in the studies mentioned above. These include differences in sampling strategies, assessment tools employed, the inclusion of patients with general medical conditions, and medications interfering with sexual function. Most of the studies in this field are cross-sectional with an inadequate characterization of the sample investigated and drawing conclusions from small, nonrepresentative, and nonrandom samples. Most of the studies predominantly focus on coital activity, equating it to the broader spectrum of sexual activity. Some of the studies also ignored the aging population’s motivational, cognitive, affective factors, sexual interests, expectations, beliefs, and satisfaction.

Physiological and Medical Aspects of Sexuality in Elderly

The Human Sexual Response Cycle
It is mediated by the complex interaction between physiological, psychological, and environmental factors. It consists of the initial phase of desire and interest, followed by four successive phases: arousal, plateau, orgasm, and resolution.36 The desire phase is characterized by sexual fantasies. It is a subjective phase and is dependent on proper and adequate neuroendocrine functioning. The phase of arousal/excitement is mediated by the parasympathetic system and is characterized by sexual pleasure, vaginal lubrication in females, penile tumescence, and erection in males. Testosterone plays a major role in both men and women during the desire and arousal phases. The sympathetic nervous system mediates the orgasm phase. It involves the peaking of sexual pleasure with the release of tension and rhythmic contraction of the perineal muscles and pelvic reproductive organs. It also consists of ejaculatory responses in men. The resolution phase consists of penile detumescence, a subjective sense of wellbeing, and relaxation. After the orgasm, men have a refractory period, which is absent in most women.

Sexual Response and Aging

Effects of Medical Illness and Medications on Sexuality
Medical illnesses such as diabetes mellitus, hypertension, dyslipidemia, hypogonadism, thyroid, and adrenal diseases, Parkinson’s disease, psychiatric disorders such as depression, anxiety, and various surgical procedures could harm the sexual functions in the elderly either directly by their pathogenesis or indirectly by generating unfounded anxiety during sexual intercourse, reducing self-confidence and desire.

Often the geriatric population would be taking multiple medications. It is worth noting that antidepressants, antipsychotics, benzodiazepines, antihypertensives, thiazide diuretics, statins, and anticonvulsants can interfere with sexual functions. The drugs such as L-dopa, lamotrigine, and trazodone may overstimulate sexual functions.

Sexuality in Older Adults: Indian Scenario
India is always viewed as a nation that is conservative in terms of sexuality. Sexuality is seldom spoken about and even less researched. When it comes to sexuality in older adults in India, very few studies have attempted to understand the sexual behaviors in late life. The study on the south Indian geriatric population has found that overall about 27% of the older population was sexually active. About half of the individuals aged 61–65 years were sexually active, which dropped significantly above the age of 75 years. Among those who were sexually active, about half of them had one or more sexual disorders. Older adults in India are often seen as individuals who are expected to generally give up their desires and interests and live a solitary life. Because of these assumptions, many older adults seldom express their desires, especially concerning sexual interests. In addition, there are many barriers to the safe expression of sexuality in India among older adults. Some of these include lack of privacy, lack of enough space in the house (often, older adults are expected to give their private room to their children), disapproval from children/grandchildren, viewing sexual expression as undignified behavior, equating menopause or andropause to the end of sexual life in older adults, and feeling of guilt toward sexual expression. Besides these, other factors but not exclusive to India are frailty, fatigue, physical morbidity, grief, death of a spouse, chronic pain, and erectile dysfunction, which prevent the expression of sexual behaviors in late life.

Social Aspects of Sexual Issues in Aging
“Ageism” is defined as “prejudicial attitudes toward the aged, the old age, and the aging process, including attitudes held by the elderly themselves and discriminatory practices against the elderly, and institutional practices and policies which, often without malice, perpetuate stereotypic beliefs about the elderly, reduce their opportunities for a satisfactory life and undermine their dignity.” Ageism complicates sexuality and sexual issues in the geriatric population.

Myths and Attitudes About Sexuality in Old Age
The myths and misconceptions are prevalent about sexuality across all age groups and genders, which are more so in the old age group, which adversely affect society’s views about the sexuality of the geriatric population. These have their origins in transgenerationally ingrained social, political, religious, cultural, and moral values and the portrayal in the popular media.

The common myths are as follows:
“Old people are prohibited from having a sexual life, and they are not sexually desirable and capable.”

“Sex means only intercourse.”

“Menopause is the end of women’s sexual life.”

“Masturbatory practices are not common and prohibited in the elderly.”

Attitudes Among Health Professionals Toward Sexuality in the Aging Population
Researchers and policymakers are also not free from age-old stereotypes about aging, leading to flawed methodologies and unrepresentative policy developments. The studies have found that negative attitudes and lack of adequate knowledge and expertise are prevalent even among doctors and nurses. The attitudes of the staff in long-term care (LTC) facilities and nursing homes are also a barrier to promoting sexual wellbeing in older adults. Research has shown that they are both negative or restrictive and positive or permissive.

The factors predictive of negative attitudes are young age, religious beliefs, and negative experiences with older people. In contrast, vocational training, higher socioeconomic status, and positive work experiences with older adults predict positive attitudes among care staff. These will have an impact on the expression of sexuality in inmates of the LTC facilities.

Sexual relationship after the death of a spouse is seen as a taboo in the society. There could be the possibilities of sexual dysfunction in a new relationship after an interim period of abstinence because of the loss of a partner, which is termed as the “widower’s syndrome.” The hesitancy to seek consultation with the professional is majorly because of the lack of awareness, compounded by stigma and ageism prevalent in the society. Among the inmates of nursing homes and residential care facilities, there could be even more negative attitudes and reactions from the staff, inmates, and others toward the formation of new intimate relationships by the older adults.

Legal and Ethical Issue
The issues of sexuality in aging populations are not out of the purview of the legal and ethical implications. There is a need for a balance between autonomy, rights, avoiding paternalism, and ensuring the safety of the patient and partner. The fact that someone is older does not automatically imply a lack of or diminished decisional capacity for sexual activity. Indeed, it is presumed that the person is cognitively capable of giving consent for sexual activity independent of age and neuropsychiatric diagnosis. On the other hand, if the decision capacity is in question, one can test the same by formal capacity assessment.

To consent to sexual relations and activities, one must have sufficient knowledge and understanding of the nature of the activity, reasonably foreseeable consequences, and the capacity to choose without coercion. This is issue-specific (having the knowledge of the nature of activity in general) and situation-specific (whether the person can consent to sexual activity with a particular person at a particular time). One must also consider the fluctuating capacity to consent in older individuals.

Other legal aspects regarding sexuality in the elderly include complaints of sexual impropriety in LTC institutions and nursing homes. The unique issues that arise while investigating include barriers such as memory recall, delusions, indicators of consent and nonconsent, and general misinterpretations. The court investigation into sexual impropriety is a lengthy and tedious procedure involving multiple court appearances, which could negatively impact the mental health of the elderly. With progressive neurodegenerative diseases, one may have a progressive decline in the capacity of decision making.

Family involvement is another complex aspect with questions such as should families or caregivers be surrogate decision makers in this regard, and to what extent should families be disclosed about the sexual incidents. Importantly, if the patient can consent and does not wish their family to know, it should be respected and kept confidential.

Elderly as Sexual Offenders
The population aging can contribute to the increase in the proportion of elderly individuals among sexual offenders. These individuals could be those having an onset of sexually offending behaviors during their younger age or those having the new onset of sexual misbehavior in later life. Older age and their social status in the society can play a significant role in perpetuating sexual offense toward the victims who may be involved in a trusted relationship with the offenders. Comorbid psychiatric illnesses may play a role in sexual perpetration.61 There are reports of the elderly getting involved in child sexual abuse when they are entrusted with the care of the children. Elderly receiving personal care assistance from the caregivers may also misinterpret these interactions and express sexually inappropriate behaviors.

Evaluation
Taking a Sexual History
Most of the curricula focus on pathological aspects of sexual functioning, ignoring the other aspects such as general sexual wellness, education, and healthy sexual functions. These are compounded by the embarrassment from both professionals and patients and ambivalence while collecting the sexual history.64 The principles of taking a sexual history include the following aspects:

-Understanding the barriers to taking a history such as lack of knowledge, fear of effects caused, using the vocabulary, role of ageism, etc.;
-Ensuring the patient’s comfort physically and mentally;
-Assuring total confidentiality;
-Interviewing couples either individually or together;
-Taking a sexual history in the initial periods of history taking;
-Using open-ended and nonthreatening questions;

Jack Annon developed the PLISSIT model in 1976 to discuss sexual health among all age groups.

PLISSIT is the acronym for:

-Permission (P): asking permission for history taking, exploring broader aspects of sexual expression.
-Limited Information (LI): gather all aspects of history, examination, lab investigations, review of medications, education, and screening regarding sexually transmitted infections, providing information on normal sexual functioning patterns in aging.
-Specific Suggestions (SS): identify the dysfunctional phase of the sexual response cycle and look for any medication side effects or effects of general medical conditions.
-Intensive Therapy (IT): both pharmacological and psychosocial interventions and refer to a specialist if required.

Conclusions and Recommendations
In the changing global scenario, it will be worthwhile to look into the various aspects of companionship and its effects on the physical and mental health of the older population. It needs to be explored how the best options of various social group activities, pets, technology, and artificial intelligence could be used as modes for providing companionship. Sexuality and sexual issues in the aging population are yet another multifaceted topic that needs to be further researched in the Indian scenario and needs further attention to biopsychosocial and legal dimensions of it.

References
ioaging.org, “The Importance of Companionship For Seniors: Socialization and Better Health.”; selecthealth.org, “Why Companionship is So Important for the Elderly and Tips for Caretakers.” By Allie Blackman; selecthealth.org, “The Feeling of Loneliness and Its Impact on Physical Health.” By Chase Doughty; “ncbi.nim.nih.gov, “Companionship and Sexual Issues in the Aging Population.” Abhishek Ramesh,1 Thomas Gregor Issac, Shiva Shanker Reddy Mukku, and Palanimuthu T. Sivakumar;

Chapter 13–Maintaining a Bright Outlook on Life

There is no denying that getting old sucks, no really sucks! I will be 60 years old this year so I speak from personal experience. I have abused my body over those years, no I have not done drugs, but I have physically abused my body related to hard work and I have suffered from repetitive use injuries. I will always remember my Father saying that I worked too hard. He also said that my body will remember every and all the damage you do to it. As you get older, your body will remind you in none too subtle ways. I used to scoff at these words of wisdom. Little did I know how prescient they would be.

While it is true that you can replace your hips, knees and shoulders via orthopedic surgeries and you can also replace some organs via transplants, these replacements are rare and for the most part someone has to die so that you can get these organs. So you cannot rely on all of these replacements to improve your life. In the not too distant future this will all change. If you want to take a look at the future just watch the Robin William’s movie Bicentennial Man.

However, even if you are fortunate enough to be the recipient of these replacements, you still have your core that is all yours. Any damage that you do to it is something that you will have to live with. In this book I have discussed all the stages of our lives, I have also discussed how exercise, diet and medicine can prolong your life. In this chapter I will wrap this discussion up with talking about how your outlook on life can affect your lifespan as well. But before I do so I will discuss a few more things that can affect your longevity.

I have done my best to live a healthy life, though sometimes there are things that are just out of your control, one of these is your genes. While you may love your grandparents, you may not love their genes. My family has a history of cardiac issues, cancer and gastrointestinal problems. The men on my father’s side of the family even have dental issues. I always wondered why my father’s brothers had so many missing teeth. Now I know why. As the men in our family get older our teeth become more brittle. Even something as simple as eating a piece of toast can cause problems with my dentition. I have had six teeth simply shatter from eating food. I had to have those teeth removed, because they were a total loss. Eventually I will have to get false teeth.

Since I have also inherited Irritable Bowel Issues from my mother’s side of the family, my diet is somewhat limited. My over reliance on starchy foods has lead me to have weight issues. Last year I had to have a gastric sleeve procedure done so that I could lose weight. I have since lost over 80 pounds. My health has improved somewhat thanks to this weight loss. I am no longer pre-diabetic and my knee and hip joints don’t hurt as much when I go for walks. In order to stay as healthy as possible I have over the years participated in endurance related activities, such as running, biking and swimming. While these activities were great for my cardiac health, the running took its toll on my body. While I no longer go jogging I do go bike riding on occasion. Even though I recently lost a lot of weight my knees are still an issue. This becomes evident when I go for hikes that involve rock hoping and scrambling. My back also bothers me from years of job related heavy lifting. I worked over 10 years stocking shelves at night in grocery stores. My back is now paying the price from all this heavy and repetitive lifting. If this wasn’t bad enough I am now an ICU nurse. Part of my job involves pulling, tugging and repositioning heavy patients. As a result I have injured my back on several occasions lifting heavy patients over the last 20 plus years of nursing.

Even though my body is literally in shambles, I try not to let this stop me from participating in the activities that I enjoy doing. Part of my ability to keep doing these activities is my stubbornness which allows me to push through the pain that I experience in hiking, kayaking, bike riding. I simply refuse to allow it to prevent me from living my life. It is however true that I have slowed down a step or two. It also takes more time for me to recover from heavy physical exertion. I have to spread these pursuits of mine out some. I simply can’t sustain doing demanding activities several days in a row. As long as I realize what my limitations are, I can still do many of the things I enjoyed when I was younger. I now use hiking poles when I go on more difficult hikes. I also go on slightly shorter hikes. I take more frequent breaks. I also bring a camera with me, so I take photos when I am resting. I try to schedule my rest stops where there is pretty scenery or points of interest.

As I get older I have come to the realization that you have to have something to look forward to. It also helps to set little goals for yourself. Not only is physical activity important to keep your body healthy, it is also important that you keep your mind active. It is simply too easy to just sit in front of the TV and vegetate. While my wife and I like to binge once in a while we do a lot of other things to keep our minds active. While I have always enjoyed reading, I have started a blog and podcast as well. I have also taken up writing books. All of these things help to keep my mind active as well as give me a more positive outlook on life. I have readers that follow my blog articles and I have listeners who listen to my podcast. While I am not setting the world on fire, I still feel that I am making a difference.

After this last little segue I will now discuss how optimism helps not only improve your outlook on life but to increase your lifespan as well. Do you tend to see the glass as half full, rather than half empty? Are you always looking on the bright side of life? If so, you might be surprised to learn that this tendency could actually be good for your health.

A number of studies have shown that optimists enjoy higher levels of well-being, better sleep, lower stress and even better cardiovascular health and immune function. And now, a study links being an optimist to a longer life.

Researchers tracked the life span of some 160,000 women ages 50 to 79 for 26 years. At the beginning of the study, the women completed a self-report measure of optimism. Women with the highest scores on the measure were categorized as optimists. Those with the lowest scores were considered pessimists.

Why some people are more optimistic than others — and why it matters

Then, in 2019, the researchers followed up with the participants who were still living. They also looked at the life span of participants who had died. What they found was that those who had the highest levels of optimism were more likely to live longer. More important, the optimists were also more likely than those who were pessimists to live into their nineties. Researchers refer to this as “exceptional longevity,” considering the average life span for women in developed countries is about 83 years.

What makes these findings especially impressive is that the results remained even after accounting for other factors known to predict a long life — including education level and economic status, ethnicity and whether a person suffered from depression or other chronic health conditions.

But given that the study looked only at women, it’s uncertain whether the same would be true for men. But another study looking at both men and women also found that people with the highest levels of optimism enjoyed a life span that was between 11 and 15 percent longer than those who were the least optimistic.

So why is it that optimists live longer? At first glance, it would seem it could have to do with their healthier lifestyles. For example, research from several studies has found that optimism is linked to eating a healthy diet, staying physically active and being less likely to smoke cigarettes. These healthy behaviors are well known to improve heart health and reduce the risk for cardiovascular disease, which is a leading cause of death globally. Adopting a healthy lifestyle is also important for reducing the risk of other potentially deadly diseases, such as diabetes and cancer.
But having a healthy lifestyle might be only part of the reason optimists live longer-than-average lives. The latest study found that lifestyle only accounted for 24 percent of the link between optimism and longevity, which suggests a number of other factors affect longevity for optimists.

Another possible reason could be the way optimists manage stress. When faced with a stressful situation, optimists tend to deal with it head-on. They use adaptive coping strategies that help them resolve the source of the stress, or view the situation in a less stressful way. For example, optimists will problem-solve and plan ways to deal with the stressor, call on others for support or try to find a “silver lining” in the stressful situation.

All of these approaches are well known to reduce feelings of stress, as well as the biological reactions that occur when we feel stressed. It’s these biological reactions to stress — such as elevated cortisol (sometimes called the “stress hormone”), increased heart rate and blood pressure, and impaired immune system functioning — that can take a toll on health over time and increase the risk for developing life-threatening illnesses, such as cardiovascular disease. In short, the way optimists cope with stress might help protect them somewhat against its harmful effects.

Optimism is typically viewed by researchers as a relatively stable personality trait that is determined by both genetic and early-childhood influences (such as having a secure and warm relationship with your parents or caregivers). But if you’re not naturally prone to seeing the glass as half full, there are some ways you can increase your capacity to be optimistic. Research shows optimism can change over time and can be cultivated by engaging in simple exercises. For example, visualizing and then writing about your “best possible self” (a future version of yourself who has accomplished your goals) is a technique that studies have found can significantly increase optimism, at least temporarily. But for best results, the goals need to be both positive and reasonable, rather than just wishful thinking. Similarly, simply thinking about positive future events can also be effective for boosting optimism.

It’s also crucial to temper any expectations for success with an accurate view of what you can and cannot control. Optimism is reinforced when we experience the positive outcomes that we expect, but it can decrease when these outcomes aren’t as we want them to be. Although more research is needed, it’s possible that regularly envisioning yourself as having the best possible outcomes, and taking realistic steps toward achieving them, can help develop an optimistic mind-set.

Of course, this might be easier said than done for some. If you’re someone who isn’t naturally optimistic, the best chance to improve your longevity entails living a healthy lifestyle by staying physically active, eating a healthy diet, managing stress and getting a good night’s sleep. Add to this cultivating a more optimistic mind-set and you might further increase your chances for a long life.

“Choose to be optimistic. It feels better,” the Dalai Lama has said. Stress can be good for you, and here’s why It may also lengthen your life. Higher levels of optimism are associated with a longer lifespan and a greater chance of living past 90, according to a new study of nearly 160,000 women of different races and backgrounds.

“Although optimism itself may be patterned by social structural factors, our findings suggest that the benefits of optimism for longevity may hold across racial and ethnic groups,” said lead author Hayami Koga, a postdoctorial student at Harvard T.H. Chan School of Public Health in a statement.

“Optimism may be an important target of intervention for longevity across diverse groups,” Koga added. This isn’t the first study to find a strong link between longevity and looking on the bright side of life. A 2019 study found both men and women with the highest levels of optimism had an average 11% to 15% longer life span than people who practiced little positive thinking. In fact, the highest-scoring optimists were most likely to live to age 85 or beyond.

The results held true, the study found, even when socioeconomic status, health conditions, depression, smoking, social engagement, poor diet and alcohol use were considered.

Optimism doesn’t mean ignoring life’s stressors, experts say. But when negative things happen, optimistic people are less likely to blame themselves and more likely to see the obstacle as temporary or even positive. Optimists also believe they have control over their fate and can create opportunities for good things to happen in the future.

Studies of twins have found only about 25% of our optimism is programmed by our genes. The rest is up to us and how we respond to life’s lemons. If you’re more likely to turn sour when stressed, don’t worry. It turns out you can train your brain to be more positive.

One of the most effective ways to increase optimism is called the “Best Possible Self” method, according to a meta-analysis of existing studies. In this intervention, you imagine yourself in a future in which you have achieved all your life goals and all of your problems have been resolved.

Begin to write for 15 minutes about specifics you have accomplished and spent five minutes imaging how that reality looks and feels. Practicing this daily can significantly improve your positive feelings, experts say.

In an 2011 study, students practiced the Best Possible Self exercise for 15 minutes once a week for eight weeks. Not only did they feel more positive, the feelings lasted for about six months.

Another way to bolster optimism is to keep a journal dedicated to only positive experiences you experienced that day. Over time, that focus on the positive can reshape your outlook, experts say.

Taking a few minutes each day to write down what makes you thankful can also improve your outlook on life. A number of studies have shown that practicing gratefulness improves positive coping skills by breaking the typical negative thinking style and substituting optimism. Counting blessings even lessened problem behavior in adolescents.

Like exercise, optimism exercises will need to be practiced on a regular basis to keep the brain’s positive outlook in good shape, experts say. But isn’t a longer, happier, more positive life worth the effort?

References
washingtonpost.com, “Why optimists live longer than the rest of us.” By Fushia Sirois; cnn.com, “Do optimists live longer? Of course they do.” By Sandee LaMotte;