Adult Development Behavioral Development Adult Development Eriksons Psychosocial Stages of Adulthood: Young Adulthood-Intimacy vs. Isolation years During mid-30s many women return to work/school/resume careers Middle Adulthood- Generativity vs. Stagnation years Midlife crisis Often triggered by loss of job / divorce Old age- Integrity vs. Despair 65 + Adult Development Marriage- approximately 95% of adults in U.S. marry Most are married and have children by age 30 Married people are found to be physically & mentally healthier than non-married Good marriage excellent predictor of health status In general strong social support is an excellent predictor of health status Adult Development Reasons most often given why marriages endure: 1. My spouse is my best friend 2. I like my spouse as a person 3. Marriage is long-term commitment 4. Marriage is sacred 5. We agree on aims and goals (Lauer & Lauer) Adult Development Divorce Approximately 50% of marriages end in divorce Factors associated with divorce: Lack of family support Marriage during teen years Divorced parents Differences in SES or religious background Serious illness or death of a child Adult Development Reasons given why marriages fail 1. communication problems 2. basic unhappiness 3. incompatibility 4. sexual problems (men say this more frequently 5. financial problems 6. emotional abuse (women say this more often) (Cleek & Pearson) Adult Development Stress in Adulthood Top stressors in adulthood: 1. Death of a child 2. Death of a spouse 3. Marital separation/divorce 4. Jail term 5. Death of a close family member 6. Personal injury or illness 7. Marriage 8. Losing Job (Holmes & Rahe) Effects of stress in Adulthood Cumulative stress impacts negatively on health Even individual stresses (divorce / loss of child / loss of child) Can lead to Midlife crisis Depression Identity crisis Demographics of Aging Our society is rapidly aging Currently individuals over 65 make up about 12% of the population In expected to climb to ~20% This has profound effects on our health care system! Number of Persons 65+ From 1900 to 2030 (in millions) Aging Demographics (Census, 2000) Individuals who reach 65 have an average life expectancy of an additional 17.9 years 19.2 for women 16.3 for men Many older adults live alone 40% for women 17% for men Marital Status of Persons 65+ (2001) Health care implications of aging society In 1999, older adults were hospitalized 4 times as often as those under 65 The average stay was 50% longer for older adults Older adults average more contacts with doctors than did persons of all ages 6.8 contacts vs 3.5 contacts Financial resources Median income for older adults (65+) $19,688 for males $11,313 for females Income from Social Security - 90% Assets - 59% Public / Private Pensions -41% Earnings - 22% Poverty rate for 65+ relatively stable at ~10% Expenditures Almost 1/3 of the drugs prescribed today are taken by older adults This group represents ~12% of the population In 1999, older consumers averaged $3,019 in out of pocket health care expenditures A 1/3 increase since 1990 Older Americans spent 11% of their total expenditures on health Chronic Conditions in Older Adults 69% of older adults are either overweight of clinically obese Rates of obesity in 65+ age group have doubled over the past 30 years After age 65, the incidence of heart failure approaches 10 in every 1,000 adults. In 2000, 72% of Americans hospitalized for stroke were age 65 and older. Chronic Conditions in Older Adults At age 75 and older 64% of men and 77% of women have hypertension. Of the nearly 70 million Americans affected with arthritis, 59% are 65 years and older Chronic Conditions in Older Adults An average of 13% of men and women ages 60+ have physician diagnosed diabetes In 1998 an average of 18% of adults aged 65 to 85+ reported symptoms of depression Chronic Conditions in Older Adults The % of older adults with moderate or severe memory impairment ranges from 4% among persons 65 to 69, to up to 36% among persons age 85 or older One out of every 2 women and one in 8 men over age 50 will have an osteoporosis-related fracture in her or his lifetime. Falls and Falls Related Problems % of individuals over 65 fall at least once a year Women are more likely to fall than men Men are more likely to die from a fall 10-15% of these falls result in a fracture Wrist / Hip Fractures These fractures often lead to hospitalization Downward spiral of health Falls and Fall Related Injury Falls occur at all ages / Falls may not be all that preventable Can reduce environmental factors Falls occur in highly active / highly inactive individuals Not necessarily fall - but consequence of fall that is most problematic Latest Interventions Promote bone health! Potentially train individuals to fall better Aging & Disability In US - Noninstitutional individuals 65+ Over 33 million have disabilities 41.9% of the over 65 population 14% have a sensory disability 28.6% have a physical disability 10.8 % have a mental disability 9.5 % have a self-care disability 20.4% have a disability that makes it difficult to leave the home Census, 2000 Disability increases with age (1997) Death & Dying Elderly and ill often wait to die until after major date (birthdays, holidays) Suicide: Associated with life stress and depression Differences by gender & race Suicide Rates by Age & Race Suicide Rates by Age & Sex Stages of Death & Dying (Kubler-Ross) Denial Refusal believe that he/she are dying Anger Anger at health professionals Bargaining Appeals to God / Religion Depression Becomes pre-occupied with death / emotionally detached Acceptance Calm and accepting of fate Variables Associated with Health Outcomes of Bereavement Sex- men do worse when wife dies Prior physical health- poor health, worse outcomes Prior mental health- poor mental health, worse outcome SES- financial problems related to worse outcomes Variables Associated with Health Outcomes of Bereavement: Relationship to deceased- Ambivalent relationship worst Nature of death- Sudden death is not necessarily worse Suicide-often results in increased distress, self-blame Social support Has positive outcome for bereaved Osterweis et al. (1984) Cultures vary greatly on how they deal with death Dia de los Muertos (Day of the Dead) The word death is not pronounced in New York, in Paris, in London, because it burns the lips..The Mexican, in contrast, is familiar with death, jokes about it, caresses it, sleeps with it, celebrates it; it is one of his favorite toys and his most steadfast love. - Octavio Paz, Nobel Prize Winner in Literature Final Aging Issues How can we improve the quality of life in older adults? Promote greater levels of activity Vigorous walking times per week has great benefits Encourage older adults to try new things Novelty stimulates the brain! Reduce rates of disability