each one’s right and responsibility to take the

THE MIDLIFE optimum measures to make the most of it

Henrietta V. Cabado-Española, MD, FPPA The aging process is one of the most significant unavoidable
July 18, 2013 changes in life.
Group 6 Life does not stop at one point
____________________________________________________ We could not stop, pause or rewind the biological
Outline: clock
• Introduction
• Phases of the Life-Cycle of Man AGING:
• Major Biological Changes Associated with Aging - not a curse or a malady
• Vital Issues Arising During the Midlife - associated with many significant and profound events
• Cruising through the Midlife and experiences
____________________________________________________ - should be acknowledged and accepted
INTRODUCTION - should not be abhorred

LIFE It is wonderful that our body has such vast resources and
• God-given gift powers of adaptations that it does not let us feel old in spite of
• Dynamic Process age, provided we do not misuse those powers or abuse its
continuum of change, adaptations and resources.
compromises Healthy habits and attitudes based on common sense principles
certain unavoidable things happen although and the will to live a long and healthy life along with the
each one plans and implements a scheme for a readiness to act if and when problems (e.g. illnesses, death)
happy, productive and satisfying existence, or even arise, are all that is necessary to be able to lead a richer, fuller
take steps to alter or correct quirks along the way and more rewarding life!
• Worth living
for each one to nurture and cherish

THE PHASES OF THE LIFE CYCLE OF MAN

 o psychiatric symptoms
30-40 – most peaceful e.g. anxiety, depression, substance abuse,
Middle adulthood (40-65) – turbulent, somewhat like psychosis, connection addiction
adolescence; people start to feel their biological toll; 2 nd
pubertal stage Middle Adulthood
50’s- prelude to retirement • frequently overwhelmed by too many obligations and
duties
ADULTHOOD • power, leadership, wisdom and understanding
• longest phase of human lifespan with exact age of onset • a time of great satisfaction
varying from person to person • THE PRIME OF LIFE
• the peak of intellectual, emotional and social (and A great time of satisfaction
spiritual) capabilities to meet demands of career, Passing of wisdom to the next generation
marriage and children (and taking care of elderly
parents) Midlife Transition (age 40-45)
• era of optimum mental functioning wherein decisions • age period somewhat arbitrary, generally differs from
for new commitments and goals are made person to person.
may sometimes be dramatic • developmental link between early adulthood and middle
adulthood
it is the period of peak potential for personal fulfillment you look back to the pat, look forward to the future
• THE NOON OF LIFE –(Carl Jung)
Early Adulthood you have lived half your life
• usually considered to begin at about age 20 (end of start to look the meaning of life in a deeper way
adolescence) and ends at age 40 “Who am I, really, really, really?” becomes more
• the peaking of biological development intent
• the assumption of major social roles More deeper questions about life
• the evolution of the adult self and life structure Ask consciously about spiritual path
Somewhat arbitrary
Early Adult Transition (age 17-22)
• sexual relationships become serious with beginning of Developmental Concerns:
quest for sexual intimacy • aging and bodily changes
• graduating from high school and entering college • taking stock of accomplishments and setting goals for
• starting a job the future
• begin to function independently • reassessing commitment to work, family and marriage
such as asking questions like “ is this really the job I
Successful passage to adulthood depends on the satisfactory want for the rest of my life?”
resolution of childhood and adolescent crises. (Erik Erikson) • dealing with new generation and relationships with
children
Age 30 Transition (age 28-33) • using accumulated power responsively and ethically
• options for occupations and marriage or other intimate • dealing with parental illness and death
relationships explored • retaining capacity to experience pleasure to engage in
• increasing concern for achieving authority, playful activity (includes sex)
independence and self-sufficiency • Wonder whether the lifestyle and commitments they
• likely to question their choices, whether the life they have chosen during early adulthood are worth
have is the one they really want. continuing.
This is also the time when the marriage goes to the There is a crisis of values. This would often result to
rocks. marital conflicts.
“The boy chases the girl, until the girl catches him” • Feel like living the remaining years in a different and
Will prompt in 40s but with more intent more satisfying way, without exactly knowing how.
• Some young people who think that their lives are doing • Redefine roles, as husbands and wives, as children leave
well reaffirm their commitments and experience a home.
smooth transition. • Make important gender adjustments
• Others may experience a major crisis, manifested by - women may release energy through individual
o marital problems pursuits that require assertiveness and competitive
especially when expectations are not met spirit
o job changes or NO JOB @ ALL
frequent job transfers is a sign of schizophrenia

2
 - men may develop qualities enabling them to express  there may be unique financial burdens
their emotions and recognize their dependence lesser turbulent time
needs.( They become nurturing.) Adulthood = expansionary stage

Age 50 Transition (age 50-55)

 clearly define what they want from work, family and The Silent Passage by Gail Sheehy
leisure o trying out 20’s
 may experience disillusionment or frustration when they o assessing 30’s
realize that they can no longer anticipate new work o fluorishing 40’s
challenges, if highest level of advancement in work has o flaming 50’s
been reached o serene 60’s
 may leave women who have invested themselves
completely to mothering with no suitable identity after
children have left home (empty nest syndrome)

• Less active sweat glands

MAJOR BIOLOGICAL CHANGES ASSOCIATED WITH • Slowed hair growth
AGING
Nothing remains static of the human body. After birth, the Special Senses
body gradually grows to full bloom and its functions reach • Reduced peripheral vision
their peak at about age of 30 then slows down and • Inability to accommodate (presbyopia)
progressively decline over the next five or six decades. • Decreased light-dark adaptation
The natural process of aging is so gradual that it is hardly • Reduced acuity of taste, smell and touch
perceptible! • High-frequency sound hearing loss (presbyacusis)
• Yellowing of optic lens
Immune System
• Impaired T-cell response to antigen Digestive System
• Increased susceptibility to infection and neoplasia • Altered absorption
• Decreased blood flow to gut, liver
Integumentary System
• Graying of hair Musculoskeletal System
• Loss of hair and slowed hair growth • Decrease in height because of shortening of spinal
• Wrinkling of skin due to loss of elasticity and turgor column

3
 • Reduction in lean muscle mass and muscle strength
• Increase in body fat
• Loss of bone matrix leading to osteoporosis
• Degeneration of joint surfaces producing osteoarthritis

Respiratory System
• Decreased vital capacity of lungs
• Diminished cough reflex
• Decreased bronchial epithelium ciliary action

Nervous System
• Decrease in gross brain weight
• Neuronal degeneration
• Decreased cerebral flow and oxygenation
• Receptor site sensitively altered

Neuropsychiatric Women: loss of libido is seldom talked about

• Takes longer to learn new material, but complete Men: loss of libido is a primary concern
learning still occurs
• Intelligence quotient (IQ) remains stable until age 80 Misconception:
• Verbal acuity maintained with age The elderly do not and should not have sexual desire or sexual
• Psychomotor speed declines activities!
• Tasks requiring shifting attentions performed with
difficulty Ignores the ‘elders’ need for sex and inhibits discussion
• Encoding ability diminishes (transfer of long-term to
short-term memory and vice-versa) The truth:
• Simple recall declines All human beings, old or young, have a natural need for
sex, both physiologically and psychologically!
Cardiovascular System
• Increase in size and weight of the heart Enjoyable Sexual Activity May Continue Well Into Old Age
• Decreased elasticity of heart valves
• Hardening of wall and narrowing of lumen of arteries CLIMACTERIUM
• Cardiac output maintained in absence of disease  period in the life of men and women characterized by a
• Altered blood pressure decrease in biological and physiological functioning
mainly focused on the gonads (ovaries and
Endocrine System testes)
• Estrogen levels decrease in women
• Testosterone production decrease in men
• Decreased insulin secretion
• Increase in FSH & LH in postmenopausal women

Urogenital System
• Decreased glomerular filtration rate and renal blood
flow
• Urinary incontinence
• Loss of ovarian and testicular function
• Decreased vaginal lubrication
• Enlargement of the prostate
• Decreased hardness of erection

VITAL ISSUES ARISING DURING MIDLIFE

4
Women o drugs
 reach their sexual prime at mid-30s such as hypotensive medications
 greater capacity for orgasm in middle than young o stress with fatigue
adulthood o anxiety
 freed of possibility of pregnancy at late 40s o disease
such as DM
MENOPAUSE = CLIMACTERIUM  90% of chronic impotence cases in middle adulthood
 may start from the 40s to early 50s, may extend over a are due to psychological rather than organic causes
period of several years
 more often a gradual process, rather than sudden or ANDROPAUSE = CLIMACTERIUM
radical psychophysiological experience, except when  ‘Male Climacteric’
surgically induced  ‘Male Menopause’
 ‘Penopause’
 PADAM (Partial Androgen Deficiency in Aging Men)
o no clear demarcation
o longer span of time from middle to late adulthood
o level of testosterone stay fairly constant from 40s to
50s when it begins to decline until 70s or 80s
no dramatic onset and usually longer compared to
menopause

Andropause: Effects and Symptoms

Physical Psychological
 Impotence  Fatigue
 Premature ejaculation  Irritability
Menopause: Effects and Symptoms  Osteoporosis  Depression

Physical Psychological  Although manifestations are more subtle, men must

 Menstrual Changes  Dizziness adapt to a diminishing biological function and overall
 Loss of breast firmness  Sensations of cold in physical vigor.
hands and feet
 Hot flushes  Insomnia Sexual Dysfunction
 Profuse sweating  Tension  Reduced sex drive or libido
o Require more touch and intense physical
 Increased weight  Fatigue
stimulation to get and maintain an erection
 Pruritus of sex organs  Headaches
o Less sexual thoughts & fantasies
 Dryness and thinning of  Depression
o Longer time for penile erection
vaginal wall
o Climax not as strong but remains a pleasurable
 Increased incidence of  Irritability
experience
vaginal infections
 Physical Changes
 Osteoporosis  Crying spells
o Hardening of blood vessels  more difficult to
get an erection
Sexual Dysfunction
o Sagging and wrinkling of scrotal tissue
 Psychological more than physical cause
o Shrinking and loss of firmness in the testes
 Narcissistic blows to self esteem as they lose their o Thickening and degeneration of the
youthful appearance seminiferous tubules  inhibits sperm
 May feel less sexually desirable than in early adulthood production
 Decreased sex drive o Enlarging of prostate gland  difficult
 Painful sexual intercourse or dyspareunia urination, weaker contractions during
orgasm, reduced force of ejaculation
MEN
 Impotence EMPTY-NEST SYNDROME
Also known as: Erectile Dysfunction, Penile  A phenomenon consisting of depression in men and
Unreliability women when the youngest child is about to leave
o excessive alcohol intake home.
5
  Spiritual Exercises
MIDLIFE CRISIS o Seek and search for TRUE SELF
o Prayer, meditation, solitude, time apart
o Individual or group support
decline in biological and severe or unexpected o Face struggles and fears
physiological make-up life events o Be kind to self

Crisis at 40 MEDICATIONS
There are issues specially with losing youth  Non-hormonal medications
o Vitamins
Emotional or Psychological Disorder Characterized by o Minerals
DEPRESSION. o Water
o Sedatives
Trigger Factors: o Other prescribed medications
• sudden drastic change in work or loss of a job  Hormonal medications
• death of a spouse or strained marital relationships o ERT (Estrogen Replacement Therapy)/HRT
• feeling of emptiness or loneliness in unmarried (Hormonal Replacement Therapy)
individuals o TRT (Testosterone Replacement Therapy)
• serious illness
e.g. stroke, MI, Cancer MANAGEMENT OF SEXUAL DYSFUNCTION
 Psychoeducation
Predisposing Factors: o Information giving
• parental discord o Correction of myths and misconceptions
 withdrawal by the same sex parent o Sexual counseling
especially during adolescence  Sexual Practices
• impulsive parents with low sense of responsibility o Adequate rest prior to sex play
• anxious parents. o Lengthen foreplay
 It connects with parents and children. o Adopt less physically demanding sexual positions
o Use lubricants
Signs of Depression  Saliva
The person…  Water
 may be morose, irritable, unusually quiet, fagged out,  KY jelly
pessimistic, listless, desperate and without zest for life  NEVER USE… Cooking oil, petroleum jelly
 may lose interest or pleasure in normal activities and  More intense stimulation of genitals
may be preoccupied with worries over small matters
which may cause worry to no one When Should You Consult Your Doctor?
 may have feelings of guilt and self-reproach, lapses in General
concentration and may have suicidal thoughts • persistent headache
• feelings of despondency or persecution
The Normal Turning Points During The Middle Age Are Usually • deterioration of memory
Mastered Without Distress! • unnatural tiredness
• giddiness
CRUISING THROUGH MIDLIFE • unsteadiness and tendency to fall
Skin
Midlife is… • formation of lumps
MORE than A CRISIS! • widespread itching
It is also a summon to grow and a challenge to change. • spots and sores which bleed easily
It is an opportunity to turn towards greater life or wholeness. • irritation or dryness of skin
It is a passage to the deeper places in us where we discover Chest
Our authenticity and we realize our limitations and grandeur. • breathlessness on exertion or at rest
• chest pain, worse on coughing or deep inspiration
LIFESTYLE MODIFICATIONS • persistent cough with or without sputum
 Stress Management: • coughing blood
o Exercise • persistent hoarseness of voice
o Nutrition • pain in center of the chest, arm, neck or throat
o Avoidance of smoking and alcohol • sudden severe weakness accompanied by
6
 • cold sweats
Eyes
• pain in or above the eye
• seeing double images
• seeing halos around objects
• flashes of light
• blurring of vision
• failing eyesight
Hearing
• loss of hearing in one or both ears
• loss of effective hearing – words not clear
• ringing in the ears
Bowels
• persistent loss of appetite
• difficulty in swallowing
• excessive thirst
• unexplained loss of weight
• persistent indigestion
• persistent or increasing constipation or diarrhea
• vomiting blood or coffee-ground material
• passing fresh blood
• black tarry stools
Urine
• bloody urine
• difficulty or pain in urination
• increased frequency and urgency of urination
• uncontrolled urination
• passing large amounts or scanty urine
• ants attracted to urine
Genitals
• irregular or unusual vaginal bleeding
• pelvic pain or discomfort
• unusual genital discharge
• itching around genitals
• erectile dysfunction
Extremities
• loss of power and sensation
• persistent trembling or shaking
• pain, stiffness or swelling of joint or bone
• pain in the calf muscles
• sensations of pins and needles or crawling ants
• numbness
• pain or discoloration of toes and fingers
• painless or painful swelling of feet or legs

Legend/source:
-previous notes
-audio

Notetakers: Group Wit n’ Wild