Physical and Cognitive Development in Middle Adulthood

chapter 15 Physical and Cognitive Development in Middle Adulthood

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A principal dancer at the Grand Opera of Paris teaches a master class for young professional dancers, transferring knowledge, skill, and passion for his art to a new generation. In middle adulthood, expertise reaches its height.

chapter outline

·   PHYSICAL DEVELOPMENT

·   Physical Changes

·   Vision

·   Hearing

·   Skin

·   Muscle–Fat Makeup

·   Skeleton

·   Reproductive System

· ■  BIOLOGY AND ENVIRONMENT  Anti-Aging Effects of Dietary Calorie Restriction

· ■  CULTURAL INFLUENCES  Menopause as a Biocultural Event

·   Health and Fitness

·   Sexuality

·   Illness and Disability

·   Hostility and Anger

·   Adapting to the Physical Challenges of Midlife

·   Stress Management

·   Exercise

·   An Optimistic Outlook

·   Gender and Aging: A Double Standard

·   COGNITIVE DEVELOPMENT

Changes in Mental Abilities

·   Cohort Effects

·   Crystallized and Fluid Intelligence

·   Individual and Group Differences

·   Information Processing

·   Speed of Processing

·   Attention

·   Memory

·   Practical Problem Solving and Expertise

·   Creativity

·   Information Processing in Context

· ■  SOCIAL ISSUES: EDUCATION  The Art of Acting Improves Memory in Older Adults

·   Vocational Life and Cognitive Development

·   Adult Learners: Becoming a Student in Midlife

·   Characteristics of Returning Students

·   Supporting Returning Students

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On a snowy December evening, Devin and Trisha sat down to read the holiday cards piled high on the kitchen counter. Devin’s 55th birthday had just passed; Trisha would turn 48 in a few weeks. During the past year, they had celebrated their 24th wedding anniversary. These milestones, along with the annual updates they received from friends, brought the changes of midlife into bold relief.

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Instead of new births, children starting school, or a first promotion at work, holiday cards and letters sounded new themes. Jewel’s recap of the past year reflected growing awareness of a finite lifespan, one in which time had become more precious. She wrote:

·  My mood has been lighter ever since my birthday. There was some burden I laid down by turning 49. My mother passed away when she was 48, so it all feels like a gift now. Blessed be!

George and Anya reported on their son’s graduation from law school and their daughter Michelle’s first year of university:

·  Anya is filling the gap created by the children’s departure by returning to college for a nursing degree. After enrolling this fall, she was surprised to find herself in the same psychology class as Michelle. At first, Anya worried about handling the academic work, but after a semester of success, she’s feeling more confident.

Tim’s message reflected continuing robust health, acceptance of physical changes, and a new burden: caring for aging parents—a firm reminder of the limits of the lifespan:

·  I used to be a good basketball player in college, but recently I noticed that my 20-year-old nephew, Brent, can dribble and shoot circles around me. It must be my age! But I ran our city marathon in September and came in seventh in the over-50 division. Brent ran, too, but he opted out a few miles short of the finish line to get some pizza while I pressed on. That must be my age, too!

The saddest news is that my dad had a bad stroke. His mind is clear, but his body is partially paralyzed. It’s really upsetting because he was getting to enjoy the computer I gave him, and it was so upbeat to talk with him about it in the months before the stroke.

Middle adulthood, which begins around age 40 and ends at about 65, is marked by narrowing life options and a shrinking future as children leave home and career paths become more determined. In other ways, middle age is hard to define because wide variations in attitudes and behaviors exist. Some individuals seem physically and mentally young at age 65—active and optimistic, with a sense of serenity and stability. Others feel old at age 40—as if their lives had peaked and were on a downhill course.

Another reason middle adulthood eludes definition is that it is a contemporary phenomenon. Before the twentieth century, only a brief interval separated the tasks of early adulthood from those of old age. Women were often widows by their mid-fifties, before their youngest child left home. And harsh living conditions led people to accept a ravaged body as a natural part of life. As life expectancy—and, with it, health and vigor—increased over the past century, adults became more aware of their own aging and mortality.

In this chapter, we trace physical and cognitive development in midlife. In both domains, we will encounter not just progressive declines but also sustained performance and compensating gains. As in earlier chapters, we will see that change occurs in manifold ways. Besides heredity and biological aging, our personal approach to passing years combines with family, community, and cultural contexts to affect the way we age.

PHYSICAL DEVELOPMENT

Physical development in middle adulthood is a continuation of the gradual changes under way in early adulthood. Even the most vigorous adults notice an older body when looking in the mirror or at family photos. Hair grays and thins, new lines appear on the face, and a fuller, less youthful body shape is evident. During midlife, most individuals begin to experience life-threatening health episodes—if not in themselves, then in their partners and friends. And a change in time orientation, from “years since birth” to “years left to live,” adds to consciousness of aging (Neugarten,  1968b ).

These factors lead to a revised physical self-image, with somewhat less emphasis on hoped-for gains and more on feared declines (Bybee & Wells,  2003 ; Frazier, Barreto, & Newman,  2012 ). Prominent concerns of 40- to 65-year-olds include getting a fatal disease, being too ill to maintain independence, and losing mental capacities. Unfortunately, many middle-aged adults fail to embrace realistic alternatives—becoming more physically fit and developing into healthy, energetic older adults. Although certain aspects of aging cannot be controlled, people can do much to promote physical vigor and good health in midlife.

image4 Physical Changes

As she dressed for work one morning, Trisha remarked jokingly to Devin, “I think I’ll leave the dust on the mirror so I can’t see the wrinkles and gray hairs.” Catching sight of her image, she continued in a more serious tone. “And look at this fat—it just doesn’t want to go! I need to fit some regular exercise into my life.” In response, Devin glanced soberly at his own enlarged midriff.

At breakfast, Devin took his glasses on and off and squinted while reading the paper. “Trish—what’s the eye doctor’s phone number? I’ve got to get these bifocals adjusted again.” As they conversed between the kitchen and the adjoining den, Devin sometimes asked Trisha to repeat herself. And he kept turning up the radio and TV volume. “Does it need to be that loud?” Trisha would ask. Apparently Devin couldn’t hear as clearly as before.

In the following sections, we look closely at the major physical changes of midlife. As we do so, you may find it helpful to refer back to  Table 13.1  on  page 435 , which provides a summary.

Vision

By the forties, difficulty reading small print is common, due to thickening of the lens combined with weakening of the muscle that enables the eye to accommodate (adjust its focus) to nearby objects. As new fibers appear on the surface of the lens, they compress older fibers toward the center, creating a thicker, denser, less pliable structure that eventually cannot be transformed at all. By age 50, the accommodative ability of the lens is one-sixth of what it was at age 20. Around age 60, the lens loses its capacity to adjust to objects at varying distances entirely, a condition called  presbyopia  (literally, “old eyes”). As the lens enlarges, the eye rapidly becomes more farsighted between ages 40 and 60 (Charman,  2008 ). Corrective lenses—or, for nearsighted people, bifocals—ease reading problems.

A second set of changes limits ability to see in dim light, which declines at twice the rate of daylight vision (Jackson & Owsley,  2000 ). Throughout adulthood, the size of the pupil shrinks and the lens yellows. In addition, starting at age 40, the vitreous (transparent gelatin-like substance that fills the eye) develops opaque areas, reducing the amount of light reaching the retina. Changes in the lens and vitreous also cause light to scatter within the eye, increasing sensitivity to glare. Devin had always enjoyed driving at night, but now he sometimes had trouble making out signs and moving objects (Owsley,  2011 ). And his vision was more disrupted by bright light sources, such as headlights of oncoming cars. Yellowing of the lens and increasing density of the vitreous also limit color discrimination, especially at the green–blue–violet end of the spectrum (Paramei,  2012 ). Occasionally, Devin had to ask whether his sport coat, tie, and socks matched.

Besides structural changes in the eye, neural changes in the visual system occur. Gradual loss of rods and cones (light- and color-receptor cells) in the retina and of neurons in the optic nerve (the pathway between the retina and the cerebral cortex) contributes to visual declines. By midlife, half the rods (which enable vision in dim light) are lost (Owsley,  2011 ). And because rods secrete substances necessary for survival of cones (which enable daylight and color vision), gradual loss of cones follows.

Middle-aged adults are at increased risk of  glaucoma , a disease in which poor fluid drainage leads to a buildup of pressure within the eye, damaging the optic nerve. Glaucoma affects nearly 2 percent of people over age 40, more often women than men. It typically progresses without noticeable symptoms and is a leading cause of blindness. Heredity contributes to glaucoma, which runs in families: Siblings of people with the disease have a tenfold increased risk, and it occurs three to four times as often in African Americans and Hispanics as in Caucasians (Guedes, Tsai, & Loewen,  2011 ; Kwon et al.,  2009 ). Starting in midlife, eye exams should include a glaucoma test. Drugs that promote release of fluid and surgery to open blocked drainage channels prevent vision loss.

Hearing

An estimated 14 percent of Americans between ages 45 and 64 suffer from hearing loss, often resulting from adult-onset hearing impairments (Center for Hearing and Communication,  2012 ). Although some conditions run in families and may be hereditary, most are age-related, a condition called  presbycusis (“old hearing”).

As we age, inner-ear structures that transform mechanical sound waves into neural impulses deteriorate through natural cell death or reduced blood supply caused by atherosclerosis. Processing of neural messages in the auditory cortex also declines. Age-related cognitive changes—in processing speed, attention, and memory—that we will take up shortly are also associated with hearing loss (Lin et al.,  2011 ). The first sign, around age 50, is a noticeable decline in sensitivity to high-frequency sounds, which gradually extends to all frequencies. Late in life, human speech becomes more difficult to make out, especially rapid speech and speech against a background of voices (Humes et al.,  2012 ). Still, throughout middle adulthood, most people hear reasonably well across a wide frequency range. And African tribal peoples display little age-related hearing loss (Jarvis & van Heerden,  1967 ; Rosen, Bergman, & Plester,  1962 ). These findings suggest factors other than biological aging are involved.

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A worker uses a grinder to smooth a metal surface in a steel manufacturing facility. Men’s hearing declines more rapidly than women’s, a difference associated with several factors, including intense noise in some male-dominated occupations.

Men’s hearing tends to decline earlier and more rapidly than women’s, a difference associated with cigarette smoking, intense noise and chemical pollutants in some male-dominated occupations, and (at older ages) high blood pressure and cerebrovascular disease, or strokes that damage brain tissue (Heltzner et al.,  2005 ; Van Eyken, Van Camp, & Van Laer,  2007 ). Government regulations requiring industries to implement such safeguards as noise monitoring, provision of earplugs, pollution control, and regular hearing tests have greatly reduced hearing damage, but some employers do not comply fully (Daniell et al.,  2006 ; Ohlemiller,  2008 ).

Most middle-aged and elderly people with hearing difficulties benefit from sound amplification with hearing aids. When perception of the human voice is affected, speaking to the person patiently, clearly, and with good eye contact, in an environment with reduced background noise, aids understanding.

Skin

Our skin consists of three layers: (1) the epidermis, or outer protective layer, where new skin cells are constantly produced; (2) the dermis, or middle supportive layer, consisting of connective tissue that stretches and bounces back, giving the skin flexibility; and (3) the hypodermis, an inner fatty layer that adds to the soft lines and shape of the skin. As we age, the epidermis becomes less firmly attached to the dermis, fibers in the dermis thin, cells in both the epidermis and dermis decline in water content, and fat in the hypodermis diminishes, leading the skin to wrinkle, loosen, and feel dry.

In the thirties, lines develop on the forehead as a result of smiling, furrowing the brow, and other facial expressions. In the forties, these become more pronounced, and “crow’s-feet” appear around the eyes. Gradually, the skin loses elasticity and begins to sag, especially on the face, arms, and legs (Khavkin & Ellis,  2011 ). After age 50, “age spots,” collections of pigment under the skin, increase. Blood vessels in the skin become more visible as the fatty layer thins.

Because sun exposure hastens wrinkling and spotting, individuals who have spent much time outdoors without proper skin protection look older than their contemporaries. And partly because the dermis of women is not as thick as that of men, women’s skin ages more quickly (Makrantonaki & Xouboulis,  2007 ).

Muscle–Fat Makeup

As Trisha and Devin make clear, weight gain—“middle-age spread”—is a concern for both men and women. A common pattern of change is an increase in body fat and a loss of lean body mass (muscle and bone). The rise in fat largely affects the torso and occurs as fatty deposits within the body cavity; as noted earlier, fat beneath the skin on the limbs declines. On average, size of the abdomen increases 7 to 14 percent. Although a large portion is due to weight gain, age-related changes in muscle–fat makeup also contribute (Stevens, Katz, & Huxley,  2010 ). In addition, sex differences in fat distribution appear. Men accumulate more on the back and upper abdomen, women around the waist and upper arms (Sowers et al.,  2007 ). Muscle mass declines very gradually in the forties and fifties, largely due to atrophy of fast-twitch fibers, responsible for speed and explosive strength.

Yet, as indicated in  Chapter 13 , large weight gain and loss of muscle power are not inevitable. With age, people must gradually reduce caloric intake to adjust for the age-related decline in basal metabolic rate (see  page 440 ). In a longitudinal study of nearly 30,000 U.S. 50- to 79-year-old women diverse in SES and ethnicity, a low-fat diet involving increased consumption of vegetables, fruits, and grains was associated with greater initial weight loss and success at maintaining that loss over a seven-year period (Howard et al.,  2006 ). In nonhuman animals, dietary restraint dramatically increases longevity while sustaining health and vitality. Currently, researchers are identifying the biological mechanisms involved and studying their relevance to humans (see the Biology and Environment box on the following page).

Furthermore, weight-bearing exercise that includes resistance training (placing a moderately stressful load on the muscles) can offset both excess weight and muscle loss. Within the same individual, strength varies between often-used and little-used muscles (Macaluso & De Vito,  2004 ; Rivlin,  2007 ). Consider Devin’s 57-year-old friend Tim, who for years has ridden his bike to and from work and jogged on weekends, averaging an hour of vigorous activity per day. Like many endurance athletes, he maintained the same weight and muscular physique throughout early and middle adulthood.

Skeleton

As new cells accumulate on their outer layers, the bones broaden, but their mineral content declines, so they become more porous. This leads to a gradual loss in bone density that begins around age 40 and accelerates in the fifties, especially among women (Clarke & Khosla,  2010 ). Women’s reserve of bone minerals is lower than men’s to begin with. And following menopause, the favorable impact of estrogen on bone mineral absorption is lost. Reduction in bone density during adulthood is substantial—about 8 to 12 percent in men and 20 to 30 percent in women (Seeman,  2008 ).

Loss of bone strength causes the disks in the spinal column to collapse. Consequently, height may drop by as much as 1 inch by age 60, a change that will hasten thereafter. In addition, the weakened bones cannot support as much load: They fracture more easily and heal more slowly. A healthy lifestyle—including weight-bearing exercise, adequate calcium and vitamin D intake, and avoidance of smoking and heavy alcohol consumption—can slow bone loss in postmenopausal women by as much as 30 to 50 percent (Cooper et al.,  2009 ).

When bone loss is very great, it leads to a debilitating disorder called osteoporosis. We will take up this condition shortly when we consider illness and disability.

Reproductive System

The midlife transition in which fertility declines is called the  climacteric.  In women, it brings an end to reproductive capacity; in men, by contrast, fertility diminishes but is retained.

Reproductive changes in Women.

The changes involved in women’s climacteric occur gradually over a 10-year period, during which the production of estrogen drops. As a result, the number of days in a woman’s monthly cycle shortens from about 28 in her twenties and thirties to perhaps 23 by her late forties, and her cycles become more irregular. In some, ova are not released; when they are, more are defective (see  Chapter 2  page 53 ). The climacteric concludes with  menopause , the end of menstruation and reproductive capacity. This occurs, on average, in the early fifties among North American, European, and East Asian women, although the age range extends from the late thirties to the late fifties (Avis, Crawford, & Johannes,  2002 ; Rossi,  2005 ). Women who smoke or who have not borne children tend to reach menopause earlier.

Following menopause, estrogen declines further, causing the reproductive organs to shrink in size, the genitals to be less easily stimulated, and the vagina to lubricate more slowly during arousal. As a result, complaints about sexual functioning increase, with about 35 to 40 percent of women reporting difficulties, especially among those with health problems or whose partners have sexual performance difficulties (Lindau et al.,  2007 ; Walsh & Berman,  2004 ). The drop in estrogen also contributes to decreased elasticity of the skin and loss of bone mass. Also lost is estrogen’s ability to help protect against accumulation of plaque on the walls of the arteries, by boosting “good cholesterol” (high-density lipoprotein).

The period leading up to and following menopause is often accompanied by emotional and physical symptoms, including mood fluctuations and hot flashes—sensations of warmth accompanied by a rise in body temperature and redness in the face, neck, and chest, followed by sweating. Hot flashes—which may occur during the day and also, as night sweats, during sleep—affect more than 50 percent of women in Western industrialized nations (Nelson,  2008 ). Typically, they are not severe: Only about 1 in 12 women experiences them every day.

Biology and Environment Anti-Aging Effects of Dietary Calorie Restriction

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An Okinawan grandfather and grandson enjoy an afternoon of kite flying. Before World War II, residents of Okinawa consumed a restricted diet that was associated with health benefits and longer life. Recent generations no longer show these advantages, possibly due to the introduction of Westernized food to Okinawa.

For nearly 70 years, scientists have known that dietary calorie restriction in nonprimate animals slows aging while maintaining good health and body functions. Rats and mice fed 30 to 40 percent fewer calories than they would freely eat beginning in early life show various physiological health benefits, lower incidence of chronic diseases, and a 60 percent increase in length of life (Fontana,  2009 ). Mild to moderate calorie restriction begun after rodents reach physical maturity also slows aging and extends longevity, though to a lesser extent. Other studies reveal similar dietary-restriction effects in mice, fleas, spiders, worms, fish, and yeast.

Nonhuman Primate Research

Would primates, especially humans, also benefit from a restricted diet? Researchers have been tracking health indicators in rhesus monkeys after placing some on regimens of 30 percent reduced calories at young, middle, and older ages. More than two decades of longitudinal findings revealed that, compared with freely eating controls, dietary-restricted monkeys were smaller but not overly thin. They accumulated body fat differently—less on the torso, a type of fat distribution that reduces middle-aged humans’ risk of heart disease.

Calorie-restricted monkeys also had a lower body temperature and basal metabolic rate—changes that suggest they shifted physiological processes away from growth to life-maintaining functions. Consequently, like calorie-restricted rodents, they seemed better able to withstand severe physical stress, such as surgery and infectious disease (Weindruch et al.,  2001 ).

Among physiological processes mediating these benefits, two seem most powerful. First, calorie restriction inhibited production of free radicals, thereby limiting cellular deterioration, which contributes to many diseases of aging (see  page 433  in  Chapter 13 ) (Carter et al.,  2007 ; Yu,  2006 ). Second, calorie restriction reduced blood glucose and improved insulin sensitivity, offering protection against diabetes and cardiovascular disease. Lower blood pressure and cholesterol and a high ratio of “good” to “bad” cholesterol in calorie-restricted primates strengthened these effects (Fontana,  2008 ).

Nevertheless, long-term tracking of the monkeys’ age of death revealed no difference in length of survival between the calorie-restricted and control groups, regardless of the age at which restriction began. Limiting food intake delayed the onset of age-related diseases, including cancer, cardiovascular disease, and arthritis, but it did not extend the monkeys’ longevity (Mattison et al.,  2012 ). In sum, the calorie-restricted monkeys benefited from more years of healthy life, not from an extended lifespan.

Human Research

Prior to World War II, residents of the island of Okinawa consumed an average of 20 percent fewer calories (while maintaining a healthy diet) than mainland Japanese citizens. Their restricted diet was associated with a 60 to 70 percent reduction in incidence of deaths due to cancer and cardiovascular disease. Recent generations of Okinawans no longer show these health and longevity advantages (Gavrilova & Gavrilov,  2012 ). The reason, some researchers speculate, is the introduction of Westernized food, including fast food, to Okinawa.

Similarly, normal-weight and overweight people who have engaged in self-imposed calorie restriction for 1 to 12 years display health benefits—reduced blood glucose, cholesterol, and blood pressure and a stronger immune-system response than individuals eating a typical Western diet (Fontana et al.,  2004  2010 ; Redman et al.,  2008 ). Furthermore, in the first experiment involving random assignment of human participants to calorie-restricted and nonrestricted conditions, the restricted group again displayed improved cardiovascular and other health indicators, suggesting reduced risk of agerelated disease (Redman & Ravussin,  2011 ).

Because nonhuman primates (unlike nonprimate animals) show no gains in length of life, researchers believe that calorie restriction is also unlikely to prolong human longevity. But the health benefits that accrue from limiting calorie intake are now well-established. They seem to result from a physiological response to food scarcity that evolved to increase the body’s capacity to survive adversity.

Nevertheless, very few people would be willing to maintain a substantially reduced diet for most of their lifespan. As a result, scientists have begun to explore calorie-restriction mimetics—agents such as natural food substances, herbs, and vigorous exercise regimens—that might yield the same health effects as calorie restriction, without dieting (Rizvi & Jha,  2011 ). These investigations are still in their early stages.

Although menopausal women tend to report increased irritability and less satisfying sleep, research using EEG and other neurobiological measures finds no links between menopause and changes in quantity or quality of sleep (Lamberg,  2007 ; Young et al.,  2002 ). Also, most studies reveal no association between menopause and depression in the general population (Soares,  2007 ; Vesco et al.,  2007 ; Woods et al.,  2008 ). Rather, women who have a previous history of depression, are physically inactive, or are experiencing highly stressful life events are more likely to experience depressive episodes during the climacteric. In view of these findings, sleep difficulties or depression should not be dismissed as temporary byproducts of menopause: These problems merit serious evaluation and treatment.

As  Figure 15.1  illustrates, compared with North American, European, African, and Middle Eastern women, Asian women report fewer menopausal complaints, including hot flashes (Obermeyer,  2000 ). Asian diets, which are low in fat and high in soy-based foods (a rich source of plant estrogen) may be involved.

Hormone Therapy.

To reduce the physical discomforts of menopause, doctors may prescribe  hormone therapy , or low daily doses of estrogen. Hormone therapy comes in two types: (1) estrogen alone, or estrogen replacement therapy (ERT), for women who have had hysterectomies (surgical removal of the uterus); and (2) estrogen plus progesterone, or hormone replacement therapy (HRT), for other women. Combining estrogen with progesterone lessens the risk of cancer of the endometrium (lining of the uterus), which has long been known as a serious side effect of hormone therapy.

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FIGURE 15.1 Percentage of menopausal women in different regions of the world reporting hot flashes.

Findings are derived from interviews with large samples in each region. Women in Asian nations, especially Japanese women, are less likely to suffer from hot flashes, perhaps because they eat soy-based foods, a rich source of plant estrogen. See the Cultural Influences box on  page 508  for additional evidence on the low rates of menopausal symptoms among Japanese women.

(Adapted from Obermeyer, 2000; Shea, 2006.)

Hormone therapy is highly successful at counteracting hot flashes and vaginal dryness. It also offers some protection against bone deterioration. Nevertheless, more than twenty experiments, in which nearly 43,000 perior postmenopausal women had been randomly assigned to take hormone therapy (ERT or HRT) or a sugar pill for at least one year and were followed for an average of seven years, revealed an array of negative consequences. Hormone therapy was associated with an increase in heart attack, stroke, blood clots, breast cancer, gallbladder disease, and deaths from lung cancer. ERT, when compared with HRT, intensified the risk of blood clots, stroke, and gallbladder disease. And women age 65 and older taking HRT showed an elevated risk of Alzheimer’s disease and other dementias (Marjoribanks et al.,  2012 ).

On the basis of available evidence, women and their doctors should make decisions about hormone therapy carefully. Women with family histories of cardiovascular disease or breast cancer are advised against it. Fortunately, the number of alternative treatments is increasing. A relatively safe migraine-headache medication, gabapentin, substantially reduces hot flashes, perhaps by acting on the brain’s temperature regulation center. At high doses, which still appear safe, gabapentin is nearly as effective as hormone therapy. Several antidepressant drugs and black cohosh, an herbal medication, are helpful as well (Guttuso,  2012 ; Thacker,  2011 ). Alternative medications are also available to protect the bones, although their long-term safety is not yet clear.

Women’s Psychological Reactions to menopause.

How do women react to menopause—a clear-cut signal that their childbearing years are over? The answer lies in how they interpret the event in relation to their past and future lives.

For Jewel, who had wanted marriage and family but never attained these goals, menopause was traumatic. Her sense of physical competence was still bound up with the ability to have children. Physical symptoms can also make menopause a difficult time (Elavsky & McAuley,  2007 ). And in a society that values a youthful appearance, some women respond to the climacteric with disappointment about a loss of sex appeal (Howell & Beth,  2002 ).

Many women, however, find menopause to be little or no trouble, regard it as a new beginning, and report improved quality of life (George,  2002 ; Mishra & Kuh,  2006 ). When more than 2,000 U.S. women were asked what their feelings were about no longer menstruating, nearly 50 percent of those currently experiencing changes in their menstrual cycles, and 60 percent of those whose periods had ceased, said they felt relieved (Rossi,  2005 ). Most do not want more children and are thankful to be freed from worry about birth control. And highly educated women usually have more positive attitudes toward menopause than those with less education (Pitkin,  2010 ).

Compared with previous generations, the baby-boom generation seems more accepting of menopause (Avis & Crawford,  2006 ). Their strong desire to cast aside old, gender-stereotyped views (such as menopause as a sign of decay and disease), their more active approach to seeking health information, and their greater willingness to openly discuss sexual topics may contribute to their generally positive adaptation.

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African-American women, who generally view menopause as normal, inevitable, even welcome, experience less irritability and moodiness during this transition than Caucasian-American women.

Other research suggests that African-American and Mexican-American women hold especially favorable views. In several studies, African-American women experienced less irritability and moodiness than Caucasian Americans (Melby, Lock, & Kaufert,  2005 ). They rarely spoke of menopause in terms of physical aging but, instead, regarded it as normal, inevitable, and even welcome (Sampselle et al.,  2002 , p. 359). Several African Americans expressed exasperation at society’s readiness to label as “crazy” middle-aged women’s authentic reactions to work- or family-based stressors that often coincide with menopause. Among Mexican-American women who have not yet adopted the language (and perhaps certain beliefs) of the larger society, attitudes toward menopause are especially positive (Bell,  1995 ). And in an investigation of more than 13,000 40- to 55-year-old U.S. women diverse in ethnicity, other factors—SES, physical health, lifestyle factors (smoking, diet, exercise, weight gain), and especially psychological stress—overshadowed menopausal status and three common symptoms (hot flashes, night sweats, and vaginal dryness) in impact on self-rated quality of life (Avis et al.,  2004 ).

The wide variation in physical symptoms and attitudes indicates that menopause is not just a hormonal event; it is also affected by cultural beliefs and practices. The Cultural Influences box on  page 508  provides a cross-cultural look at women’s experience of menopause.

Reproductive Changes in Men.

Although men also experience a climacteric, no male counterpart to menopause exists. Both quantity and motility of sperm decrease from the twenties on, and quantity of semen diminishes after age 40, negatively affecting fertility in middle age (Sloter et al.,  2006 ). Still, sperm production continues throughout life, and men in their nineties have fathered children. Testosterone production also declines with age, but the change is minimal in healthy men who continue to engage in sexual activity, which stimulates cells that release testosterone.

Nevertheless, because of reduced blood flow to and changes in connective tissue in the penis, more stimulation is required for an erection, and it may be harder to maintain. The inability to attain an erection when desired can occur at any age, but it becomes more common in midlife, affecting about 34 percent of U.S. men by age 60 (Shaeer & Shaeer,  2012 ).

An episode or two of impotence is not serious, but frequent bouts can lead some men to fear that their sex life is over and undermine their self-image. Viagra and other drugs that increase blood flow to the penis offer temporary relief from erectile dysfunction. Publicity surrounding these drugs has prompted open discussion of erectile dysfunction and encouraged more men to seek treatment (Berner et al.,  2008 ). But those taking the medications are often not adequately screened for the host of factors besides declining testosterone that contribute to impotence, including disorders of the nervous, circulatory, and endocrine systems; anxiety and depression; pelvic injury; and loss of interest in one’s sexual partner (Montorsi,  2005 ). Although drugs for impotence are generally safe, a few users have experienced serious vision loss (O’Malley,  2006 ). In men with high blood pressure or atherosclerosis, the medications heighten the risk of constricting blood vessels in the optic nerve, permanently damaging it.

ASK YOURSELF

REVIEW Describe cultural influences on the experience of menopause.

CONNECT Compare ethnic variations in attitudes toward menopause with ethnic variations in reactions to menarche and early pubertal timing ( pages 368  and  370  in  Chapter 11 ). Did you find similarities? Explain.

APPLY Between ages 40 and 50, Nancy gained 20 pounds. She also began to have trouble opening tightly closed jars, and her calf muscles ached after climbing a flight of stairs. “Exchanging muscle for fat must be an inevitable part of aging,” Nancy thought. Is she correct? Why or why not?

REFLECT In view of the benefits and risks of hormone therapy, what factors would you consider, or advise others to consider, before taking such medication?

Cultural Influences Menopause as a Biocultural Event

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For these rural Mayan women of the Yucatán, menopause brings freedom. After decades of childbearing, Mayan women welcome menopause, describing it as “being happy” and “free like a young girl again.”

Biology and culture join forces to influence women’s response to menopause, making it a biocultural event. In Western industrialized nations, menopause is “medicalized”—assumed to be a syndrome requiring treatment. Many women experience physical and emotional symptoms (Chrisler,  2008 ; Houck,  2006 ). The more symptoms they report, the more negative their attitude toward menopause tends to be.

Yet change the circumstances in which menopause is evaluated, and attitudes change as well. In one study, nearly 600 men and women between ages 19 and 85 described their view of menopause in one of three contexts—as a medical problem, as a life transition, or as a symbol of aging (Gannon & Ekstrom,  1993 ). The medical context evoked many more negative statements than the other contexts.

Research in non-Western cultures reveals that middle-aged women’s social status also affects the experience of menopause. In societies where older women are respected and the mother-in-law and grandmother roles bring new privileges and responsibilities, complaints about menopausal symptoms are rare (Fuh et al.,  2005 ). Perhaps in part for this reason, women in Asian nations report fewer discomforts (Shea,  2006 ). And their symptoms usually differ from those of Western women.

Though they rarely complain of hot flashes, the most frequent symptoms of Asian women are back, shoulder, and joint pain, a possible biological variation from other ethnic groups (Haines et al.,  2005 ; Huang,  2010 ). In midlife, women in Asian cultures attain peak respect and responsibility. Typically their days are filled with monitoring the household economy, attending to grandchildren, caring for dependent parents-in-law, and employment. Asian women seem to interpret menopausal distress in light of these socially valued commitments. In Japan, neither women nor their doctors consider menopause to be a significant marker of female middle age. Rather, midlife is viewed as an extended period of “socially recognized, productive maturity” (Menon,  2001 , p. 58).

A comparison of rural Mayan women of the Yucatán with rural Greek women on the island of Evia reveals additional biocultural influences on the menopausal experience (Beyene,  1992 ; Beyene & Martin,  2001 ; Mahady et al.,  2008 ). In both societies, old age is a time of increased status, and menopause brings release from child rearing and more time for leisure activities. Otherwise, Mayan and Greek women differ greatly.

Mayan women marry as teenagers. By 35 to 40, they have given birth to many children but rarely menstruated because of repeated pregnancies and breastfeeding. They also experience menopause up to 10 years earlier than their counterparts in developed nations, perhaps because of additional physical stressors, such as poor nutrition and heavy physical work. Eager for childbearing to end, they welcome menopause, describing it with such phrases as “being happy” and “free like a young girl again.” None report hot flashes or any other symptoms.

Like North Americans, rural Greek women use birth control to limit family size, and most report hot flashes and sweating at menopause. But they regard these as temporary discomforts that will stop on their own, not as medical symptoms requiring treatment. When asked what they do about hot flashes, the Greek women reply, “Pay no attention,” “Go outside for fresh air,” and “Throw off the covers at night.”

Does frequency of childbearing affect menopausal symptoms, as this contrast between Mayan and Greek women suggests? More research is needed to be sure. At the same time, the difference between North American and Greek women in attitudes toward and management of hot flashes is striking (Melby, Lock, & Kaufert,  2005 ). This—along with other cross-cultural findings—highlights the combined impact of biology and culture on menopausal experiences.

image10 Health and Fitness

In midlife, nearly 85 percent of Americans rate their health as either “excellent” or “good”—still a large majority, but lower than the 95 percent figure in early adulthood (U.S. Department of Health and Human Services,  2012c ). Whereas younger people usually attribute health complaints to temporary infections, middle-aged adults more often point to chronic diseases. As we will see, among those who rate their health unfavorably, men are more likely to suffer from fatal illnesses, women from nonfatal, limiting health problems.

In addition to typical negative indicators—major diseases and disabling conditions—our discussion takes up sexuality as a positive indicator of health. Before we begin, it is important to note that our understanding of health in middle and late adulthood is limited by insufficient research on women and ethnic minorities. Most studies of illness risk factors, prevention, and treatment have been carried out on men. Fortunately, this situation is changing. For example, the Women’s Health Initiative (WHI)—a commitment by the U.S. federal government, extending from 1993 to 2005, to study the impact of various lifestyle and medical prevention strategies on the health of nearly 162,000 postmenopausal women of all ethnic groups and SES levels—has led to important findings, including health risks associated with hormone therapy, discussed earlier. Two five-year extensions, involving annual health updates from 115,000 WHI participants in 2005–2010, and 94,000 participants in 2010–2015, continue to yield vital information.

Sexuality

Frequency of sexual activity among married couples tends to decline in middle adulthood, but for most, the drop is slight. In the National Social Life, Health, and Aging Project, a nationally representative sample of 3,000 U.S. middle-aged and older adults was surveyed about their sex lives. Even in the latter years of midlife (ages 57 to 64), the overwhelming majority of married and cohabiting adults were sexually active (90 percent of men and 80 percent of women) (Waite et al.,  2009 ). About two-thirds reported having sex several times a month, one-third once or twice a week.

Longitudinal research reveals that stability of sexual activity is far more typical than dramatic change. Couples who have sex often in early adulthood continue to do so in midlife (Dennerstein & Lehert,  2004 ; Walsh & Berman,  2004 ). And the best predictor of sexual frequency is marital happiness, an association that is probably bidirectional (DeLamater,  2012 ). Sex is more likely to occur in the context of a good marriage, and couples who have sex often probably view their relationship more positively.

Nevertheless, intensity of sexual response diminishes in midlife due to physical changes of the climacteric. Both men and women take longer to feel aroused and to reach orgasm (Bartlik & Goldstein,  2001 ; Walsh & Berman,  2004 ). If partners perceive each other as less attractive, this may contribute to a drop in sexual desire. Yet in the context of a positive outlook, sexual activity can become more satisfying. Devin and Trisha, for example, viewed each other’s aging bodies with acceptance and affection—as a sign of their enduring and deepening relationship. And with greater freedom from the demands of work and family, their sex life became more spontaneous. The majority of married people over age 50 say that their sex life is an important component of their relationship (Waite et al.,  2009 ). And most find ways to overcome difficulties with sexual functioning. One happily married 52-year-old woman commented, “We know what we are doing, we’ve had plenty of practice (laughs), and I would never have believed that it gets better as you get older, but it does” (Gott & Hinchliff,  2003 , p. 1625; Kingsberg,  2002 ).

When surveys include both married and unmarried people, a striking gender difference in age-related sexual activity appears. The proportion of U.S. men with no sexual partners in the previous year increases only slightly, from 8 percent in the thirties to 12 percent in the late fifties. In contrast, the rise for women is dramatic, from 9 percent to 40 percent—a gender gap that becomes even greater in late adulthood (Laumann & Mahay,  2002 ; Lindau et al.,  2007 ; Waite et al.,  2009 ). A higher male mortality rate and the value women place on affection and continuity in sexual relations make partners less available to them. Taken as a whole, the evidence reveals that sexual activity in midlife, as in earlier periods, is the combined result of biological, psychological, and social forces.

Illness and Disability

As  Figure 15.2  shows, cancer and cardiovascular disease are the leading causes of U.S. deaths in middle age. Unintentional injuries, though still a major health threat, occur at a lower rate than in early adulthood, largely because motor vehicle collisions decline. Despite a rise in vision problems, older adults’ many years of driving experience and greater cautiousness may reduce these deaths. In contrast, falls resulting in bone fractures and death nearly double from early to middle adulthood (U.S. Census Bureau,  2012 ).

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FIGURE 15.2 Leading causes of death among people age 45 to 64 in the United states.

Men are more vulnerable than women to each leading cause of death. Cancer is the leading killer of both sexes, by a far smaller margin over cardiovascular disease for men than for women.

(Adapted from U.S. Census Bureau, 2012.)

As in earlier decades, economic disadvantage is a strong predictor of poor health and premature death, with SES differences widening in midlife (Smith & Infurna,  2011 ). And largely because of more severe poverty and lack of universal health insurance, the United States continues to exceed most other industrialized nations in death rates from major causes (OECD,  2012 ). Furthermore, men are more vulnerable than women to most health problems. Among middle-aged men, cancer deaths exceed cardiovascular disease deaths by a small margin; among women, cancer is by far the leading cause of death (refer again to  Figure 15.2 ). Finally, as we take a closer look at illness and disability in the following sections, we will encounter yet another familiar theme: the close connection between psychological and physical well-being. Personality traits that magnify stress—especially hostility and anger—are serious threats to health in midlife.

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FIGURE 15.3 Incidence of 10 leading cancer types among men and women in the united states, 2012.

(From R. Siegel, D. Naishadham, & A. Jemal, 2012, “Cancer Statistics, 2012,” CA: A Cancer Journal for Clinicians, 62, p. 13. Copyright © 2012 American Cancer Society, Inc. Reproduced with permission of Wiley Inc.)

Cancer.

From early to middle adulthood, the death rate due to cancer multiplies tenfold, accounting for about one-third of all midlife deaths in the United States. Although the incidence of many types of cancer is currently leveling off or declining, cancer mortality was on the rise for many decades, largely because of a dramatic increase in lung cancer due to cigarette smoking. Lung cancer is the most common cause of cancer deaths in both genders, worldwide. In the past two decades, its incidence dropped in men; 50 percent fewer smoke today than in the 1950s. In contrast, lung cancer has just begun to decrease in women after a long period of increase, due to large numbers of women taking up smoking in the decades after World War II (American Cancer Society,  2012 ).

Cancer occurs when a cell’s genetic program is disrupted, leading to uncontrolled growth and spread of abnormal cells that crowd out normal tissues and organs. Why does this happen? Mutations of three main kinds contribute to cancer. Some result in oncogenes (cancer genes) that directly undergo abnormal cell duplication. Others interfere with the activity of tumor suppressor genes so they fail to keep oncogenes from multiplying. And a third type of mutation disrupts the activity of stability genes, which normally keep genetic alterations to a minimum by repairing subtle DNA mistakes that occur either during normal cell duplication or as a result of environmental agents (Ewald & Ewald,  2012 ). When stability genes do not function, mutations in many other genes occur at a higher rate.

Each of these cancer-linked mutations can be either germ-line (due to an inherited predisposition) or somatic (occurring in a single cell, which then multiplies) (see  page 52  in  Chapter 2  to review). Recall from  Chapter 13  that according to one theory, error in DNA duplication increases with age, either occurring spontaneously or resulting from the release of free radicals or breakdown of the immune system. Environmental toxins may initiate or intensify this process.

Figure 15.3  shows the incidence of the most common types of cancer. For cancers that affect both sexes, men are generally more vulnerable than women. The difference may be due to genetic makeup, exposure to cancer-causing agents as a result of lifestyle or occupation, and men’s greater tendency to delay going to the doctor. Although the relationship of SES to cancer varies with site (for example, lung and stomach cancers are linked to lower SES, breast and prostate cancers to higher SES), cancer death rates increase sharply as SES decreases and are especially high among low-income ethnic minorities (Clegg et al.,  2009 ). Poorer medical care and reduced ability to fight the disease, due to inadequate diet and high life stress, underlie this trend.

Overall, a complex interaction of heredity, biological aging, and environment contributes to cancer. For example, many patients with familial breast cancer who respond poorly to treatment have defective forms of particular tumor-suppressor genes (either BRCA1 or BRCA2). Women with these mutations are especially likely to develop early- onset breast cancer, before age 30 (Ripperger et al.,  2009 ). But their risk remains elevated throughout middle and late adulthood, when breast cancer rises among women in general. Genetic screening is available, permitting prevention efforts to begin early. Nevertheless, breast cancer susceptibility genes account for only 5 to 10 percent of all cases; most women with breast cancer do not have a family history (American Cancer Society,  2012 ). Other genes and lifestyle factors—including alcohol consumption, overweight, physical inactivity, never having had children, use of oral contraceptives, and hormone therapy to treat menopausal symptoms—heighten their risk.

People often fear cancer because they believe it is incurable. Yet nearly 60 percent of affected individuals are cured—free of the disease for five years or longer. Survival rates, however, vary widely with type of cancer (Siegel, Naishadham, & Jemal,  2012 ). For example, they are relatively high for breast and prostate cancers, intermediate for cervical and colon cancers, and low for lung and pancreatic cancers.

Applying What We Know Reducing Cancer Incidence and Deaths

Intervention Description
Know the seven warning signs of cancer. The signs are change in bowel or bladder habits, sore that does not heal, unusual bleeding or discharge, thickening or lump in a breast or elsewhere in your body, indigestion or swallowing difficulty, obvious change in a wart or mole, nagging cough or hoarseness. If you have any of these signs, consult your doctor immediately.
Schedule regular medical checkups and cancer-screening tests. Women should have a mammogram and Pap test every one to two years. Beginning at age 50, men should have an annual prostate screening test. Both men and women should be screened periodically for colon cancer, as recommended by their doctor.
Avoid tobacco. Cigarette smoking causes 90 percent of lung cancer deaths and 30 percent of all cancer deaths. Smokeless (chewing) tobacco increases risk of cancers of the mouth, larynx, throat, and esophagus.
Limit alcohol consumption. Consuming more than one drink per day for women or two drinks per day for men increases risk of cancers of the breast, kidney, liver, head, and neck.
Avoid excessive sun exposure. Sun exposure causes many cases of skin cancer. When in the sun for an extended time, wear sunglasses, use sunscreen that protects against both UVA and UVB rays, and cover exposed skin.
Avoid unnecessary X-ray exposure. Excessive exposure to X-rays increases risk of many cancers. Most medical X-rays are adjusted to deliver the lowest possible dose but should not be used unnecessarily.
Avoid exposure to industrial chemicals and other pollutants. Exposure to nickel, chromate, asbestos, vinyl chloride, radon, and other pollutants increases risk of various cancers.
Weigh the benefits versus risks of hormone therapy. Because estrogen replacement increases risk of uterine and breast cancers, carefully consider hormone therapy with your doctor.
Maintain a healthy diet. Eating vegetables, fruits, and whole grains, while avoiding excess dietary fat and salt-cured, smoked, and nitrite-cured foods, reduces risk of colon and rectal cancers.
Avoid excessive weight gain. Overweight and obesity increase risk of cancers of the breast, colon, esophagus, uterus, and kidney.
Adopt a physically active lifestyle. Physical activity offers protection against cancers at all body sites except the skin, with the strongest evidence for cancers of the breast, rectum, and colon.

Source: American Cancer Society, 2012.

Breast cancer is the leading malignancy for women, prostate cancer for men. Lung cancer ranks second for both sexes; it causes more deaths (largely preventable through avoiding tobacco) than any other cancer type. It is followed closely in incidence by colon and rectal cancer. Scheduling annual medical checkups that screen for these and other forms of cancer and taking the additional steps listed in Applying What We Know above can reduce cancer illness and death rates considerably. An increasing number of cancer-promoting mutations are being identified, and promising new therapies targeting these genes are being tested.

Surviving cancer is a triumph, but it also brings emotional challenges. During cancer treatment, relationships focus on the illness. Afterward, they must refocus on health and full participation in daily life. Unfortunately, stigmas associated with cancer exist (Daher,  2012 ). Friends, family, and co-workers may need reminders that cancer is not contagious and that with patience and support from supervisors and co-workers, cancer survivors regain their on-the-job productivity.

Cardiovascular Disease.

Despite a decline over the last few decades (see  Chapter 13 ), each year about 25 percent of middle-aged Americans who die succumb to cardiovascular disease (U.S. Department of Health and Human Services,  2012c ). We associate cardiovascular disease with heart attacks, but Devin, like many middle-aged and older adults, learned of the condition during an annual checkup. His doctor detected high blood pressure, high blood cholesterol, and atherosclerosis—a buildup of plaque in his coronary arteries, which encircle the heart and provide its muscles with oxygen and nutrients. These indicators of cardiovascular disease are known as “silent killers” because they often have no symptoms.

When symptoms are evident, they take different forms. The most extreme is a heart attack—blockage of normal blood supply to an area of the heart, usually brought on by a blood clot in one or more plaque-filled coronary arteries. Intense pain results as muscle in the affected region dies. A heart attack is a medical emergency; over 50 percent of victims die before reaching the hospital, another 15 percent during treatment, and an additional 15 percent over the next few years (Go et al.,  2013 ). Among other, less extreme symptoms of cardiovascular disease are arrhythmia, or irregular heartbeat. When it persists, it can prevent the heart from pumping enough blood and result in faintness. It can also allow clots to form within the heart’s chambers, which may break loose and travel to the brain. In some individuals, indigestion-like pain or crushing chest pain, called angina pectoris, reveals an oxygen-deprived heart.

Applying What We Know Reducing the Risk of Heart Attack

Intervention Risk Reduction
Quit smoking. Five years after quitting, greatly reduces risk compared to current smokers. Chemicals in tobacco smoke damage the heart and blood vessels and greatly increase the risk of atherosclerosis.
Reduce blood cholesterol level. Reductions in cholesterol average 10 percent with transition to a healthy diet.
Treat high blood pressure. Places added force against the artery walls, which can damage the arteries over time. Combination of healthy diet and drug therapy can lower blood pressure substantially.
Maintain ideal weight. Greatly reduced risk for people who maintain ideal body weight compared to those who are obese.
Exercise regularly. Greatly reduced risk for people who maintain an active rather than a sedentary lifestyle. In addition to contributing to healthy weight, lowers cholesterol and blood pressure and helps prevent type 2 diabetes, which is strongly linked to heart disease.
Drink an occasional glass of wine or beer. a Modestly reduced risk for people who consume small-to-moderate amounts of alcohol. Believed to promote high-density lipoproteins (a form of “good cholesterol” that lowers “bad cholesterol”) and to prevent clot formation.
If medically recommended, take low-dose aspirin. Modestly reduced risk for people with a previous heart attack or stroke, by lowering the likelihood of blood clots (should be doctor advised; long-term use can have serious side effects).
Reduce hostility and other forms of psychological stress. People under stress are more likely to engage in high-risk behaviors, such as overeating and smoking, and to display high-risk symptoms, such as high blood pressure.

a Recall from  Chapter 13  that heavy alcohol use increases the risk of cardiovascular disease as well as many other diseases.

Source: Go et al., 2013.

Today, cardiovascular disease can be treated in many ways—including coronary bypass surgery, medication, and pacemakers to regulate heart rhythm. To relieve arterial blockage, Devin had angioplasty, a procedure in which a surgeon threaded a needle-thin catheter into his arteries and inflated a balloon at its tip, which flattened fatty deposits to allow blood to flow more freely. Unless Devin took other measures to reduce his risk, his doctor warned, the arteries would clog again within a year. As Applying What We Know above indicates, adults can do much to prevent heart disease or slow its progress.

Some risks, such as heredity, advanced age, and being male, cannot be changed. But cardiovascular disease is so disabling and deadly that people must be alert for it where they least expect it—for example, in women. Because men account for over 70 percent of cases in middle adulthood, doctors often view a heart condition as a “male problem” and frequently overlook women’s symptoms, which tend to be milder, more often taking the form of angina than a heart attack (Go et al.,  2013 ). In follow-ups of victims of heart attacks, women—especially African-American women, who are at increased risk—were less likely to be offered drugs to treat blood clots and costly, invasive therapies, such as angioplasty and bypass surgery (Lawton,  2011 ; Mosca, Conner, & Wenger,  2012 ; Poon et al.,  2012 ). As a result, treatment outcomes—including rehospitalization and death—tend to be worse for women, particularly black women.

Osteoporosis.

When age-related bone loss is severe, a condition called  osteoporosis  develops. The disorder, affecting about 10 million U.S. adults, 80 percent of whom are women, greatly magnifies the risk of bone fractures. An estimated 55 percent of people over age 50 are at risk for osteoporosis because they have bone density levels low enough to be of concern, and 12 percent have been diagnosed with it (American Academy of Orthopaedic Surgeons,  2009 ). After age 70, osteoporosis affects the majority of people of both sexes. Although we associate it with a slumped-over posture, a shuffling gait, and a “dowager’s hump” in the upper back, this extreme is rare. Because the bones gradually become more porous over many years, osteoporosis may not be evident until fractures—typically in the spine, hips, and wrist—occur or are discovered through X-rays.

A major factor related to osteoporosis is the decline in estrogen associated with menopause. In middle and late adulthood, women lose about 50 percent of their bone mass, about half of it in the first 10 years following menopause—a decline that, by the late sixties, is two to five times greater than in men (Bonnick,  2008 ). The earlier a woman reaches menopause, the greater her chances of developing osteoporosis related to estrogen loss. In men, the age-related decrease in testosterone—though much more gradual than estrogen loss in women—contributes to bone loss because the body converts some to estrogen.

Heredity plays an important role. A family history of osteoporosis increases risk, with identical twins more likely than fraternal twins to share the disorder (Ralston & Uitterlinden,  2010 ). People with thin, small-framed bodies are more likely to be affected because they typically attain a lower peak bone mass in adolescence. In contrast, higher bone density makes African Americans less susceptible than Asian Americans, Caucasians, Hispanics, and Native Americans (Cauley,  2011 ). An unhealthy lifestyle also contributes: A diet deficient in calcium and vitamin D (essential for calcium absorption), excess intake of sodium and caffeine, and physical inactivity reduce bone mass. Cigarette smoking and alcohol consumption are also harmful because they interfere with replacement of bone cells (Body et al.,  2011 ; Langsetmo et al.,  2012 ).

When major bone fractures (such as the hip) occur, 10 to 20 percent of patients die within a year (Marks,  2010 ). Osteoporosis usually develops earlier in women than in men, so it has become known as a “women’s disease.” Men are far less likely to be screened and treated for it, even after a hip fracture. Compared with women, men with hip fractures tend to be older and to lack a history of interventions aimed at preserving bone density. Probably for these reasons, the one-year mortality rate after hip fracture is nearly twice as great for men as for women—a gap that widens with age (Haentjens et al.,  2010 ).

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Physical inactivity increases the chances of osteoporosis. More than half of people over age 50, mostly women, are at risk. Weight-bearing exercise and strength training are recommended for both prevention and treatment.

To treat osteoporosis, doctors recommend a diet enriched with calcium and vitamin D, weight-bearing exercise (walking rather than swimming), resistance training, and bone-strengthening medications (American Academy of Orthopaedic Surgeons,  2009 ). A better way to reduce lifelong risk is through early prevention: maximizing peak bone density by increasing calcium and vitamin D intake and engaging in regular exercise in childhood, adolescence, and early adulthood.

Hostility and Anger

Whenever Trisha’s sister Dottie called, she seemed like a powder keg ready to explode. Dottie was critical of her boss at work and dissatisfied with the way Trisha, a lawyer, had handled the family’s affairs after their father died. Inevitably, Dottie’s anger surfaced, exploding in hurtful remarks: “Any lawyer knows that, Trisha. How could you be so stupid! I should have called a real lawyer.” “You and Devin are so stuck in your privileged lives that you can’t think of anyone else. You don’t know what work is.

After listening as long as she could bear, Trisha would warn, “Dottie, if you continue, I’m going to hang up…. Dottie, I’m ending this right now!”

At age 53, Dottie had high blood pressure, difficulty sleeping, and back pain. In the past five years, she had been hospitalized five times—twice for treatment of digestive problems, twice for an irregular heartbeat, and once for a benign tumor on her thyroid gland. Trisha often wondered whether Dottie’s personal style was partly responsible for her health problems.

That hostility and anger might have negative effects on health is a centuries-old idea. Several decades ago, researchers first tested this notion by identifying 35- to 59-year-old men who displayed the Type A behavior pattern—extreme competitiveness, ambition, impatience, hostility, angry outbursts, and a sense of time pressure. They found that within the next eight years, Type As were more than twice as likely as Type Bs (people with a more relaxed disposition) to develop heart disease (Rosenman et al.,  1975 ).

Later studies, however, often failed to confirm these results. Type A is actually a mix of behaviors, only one or two of which affect health. Current evidence pinpoints hostility as a “toxic” ingredient of Type A, since isolating it from global Type A consistently predicts heart disease and other health problems in both men and women (Aldwin et al.,  2001 ; Eaker et al.,  2004 ; Matthews et al.,  2004 ; Smith et al.,  2004 ). The risks of high blood pressure, atherosclerosis, and stroke are several times greater in adults scoring high on hostility measures than in those scoring low (Räikkönen et al.,  2004 ; Williams et al.,  2002 ; Yan et al.,  2003 ).

Expressed hostility in particular—frequent angry outbursts; rude, disagreeable behavior; critical and condescending nonverbal cues during social interaction, including glares; and expressions of contempt and disgust—predicts greater cardiovascular arousal, coronary artery plaque buildup, and heart disease (Haukkala et al.,  2010 ; Julkunen & Ahlström,  2006 ; Smith & Cundiff,  2011 ; Smith et al.,  2012 ). As people get angry, heart rate, blood pressure, and stress hormones escalate until the body’s response is extreme.

Of course, people who are repeatedly enraged are more likely to be depressed and dissatisfied with their lives, to lack social supports, and to engage in unhealthy behaviors. But hostility predicts health problems even after such factors as smoking, alcohol consumption, overweight, general unhappiness, and negative life events are controlled (Smith & Mackenzie,  2006 ).

Another unhealthy feature of the Type A pattern, which also predicts heart disease, is a socially dominant style, evident in rapid, loud, insistent speech and a tendency to cut off and talk over others (Smith,  2006 ; Smith, Gallo, & Ruiz,  2003 ). And because men score higher in hostility and dominance than women (Dottie is an exception), emotional style may contribute to the sex differences in heart disease described earlier.

Can Dottie preserve her health by bottling up her hostility instead of expressing it? Repeatedly suppressing overt anger or ruminating about past anger-provoking events is also associated with high blood pressure and heart disease (Eaker et al.,  2007 ; Hogan & Linden,  2004 ). A better alternative, as we will see, is to develop effective ways of handling stress and conflict.

image14 Adapting to the Physical Challenges of Midlife

Middle adulthood is often a productive time of life, when people attain their greatest accomplishments and satisfactions. Nevertheless, it takes considerable stamina to cope with the full array of changes this period can bring. Devin responded to his expanding waistline and cardiovascular symptoms by leaving his desk twice a week to attend a low-impact aerobics class and by reducing job-related stress through daily 10-minute meditation sessions. Aware of her sister Dottie’s difficulties, Trisha resolved to handle her own hostile feelings more adaptively. And her generally optimistic outlook enabled her to cope successfully with the physical changes of midlife, the pressures of her legal career, and Devin’s cardiovascular disease.

Stress Management

TAKE A MOMENT…  Turn back to  Chapter 13  pages 449  450 , and review the negative consequences of psychological stress on the cardiovascular, immune, and gastrointestinal systems. As adults encounter problems at home and at work, daily hassles can add up to a serious stress load. Stress management is important at any age, but in middle adulthood it can limit the age-related rise in illness and, when disease strikes, reduce its severity.

Applying What We Know on the following page summarizes effective ways to reduce stress. Even when stressors cannot be eliminated, people can change how they handle some and view others. At work, Trisha focused on problems she could control—not on her boss’s irritability but on ways to delegate routine tasks to her staff so she could focus on challenges that required her knowledge and skills. When Dottie phoned, Trisha learned to distinguish normal emotional reactions from unreasonable self-blame. Instead of interpreting Dottie’s anger as a sign of her own incompetence, she reminded herself of Dottie’s difficult temperament and hard life. And greater life experience helped her accept change as inevitable, so that she was better-equipped to deal with the jolt of sudden events, such as Devin’s hospitalization for treatment of heart disease.

Notice how Trisha called on two general strategies for coping with stress, discussed in  Chapter 10 : (1) problem-centered coping, in which she appraised the situation as changeable, identified the difficulty, and decided what to do about it; and (2) emotion-centered coping, which is internal, private, and aimed at controlling distress when little can be done about a situation. Longitudinal research shows that adults who effectively reduce stress move flexibly between problem-centered and emotion-centered techniques, depending on the situation (Zakowski et al.,  2001 ). Their approach is deliberate, thoughtful, and respectful of both themselves and others.

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Stress management in middle adulthood helps limit the age-related rise in illness. This midlifer reduces stress by periodically leaving her high-pressure office environment to work in a tranquil, picturesque setting.

Notice, also, that problem-focused and emotion-focused coping, though they have different immediate goals, facilitate each other. Effective problem-focused coping reduces emotional distress, while effective emotion-focused coping helps people face problems more calmly and, thus, generate better solutions. Ineffective coping, in contrast, is largely emotion-centered and self-blaming, impulsive, or escapist.

Constructive approaches to anger reduction are a vital health intervention (refer again to Applying What We Know). Teaching people to be assertive rather than hostile and to negotiate rather than explode interrupts the intense physiological response that intervenes between psychological stress and illness. Sometimes it is best to delay responding by simply leaving a provocative situation, as Trisha did when she told Dottie that she would hang up after one more insult.

Applying What We Know Managing Stress

Strategy Description
Reevaluate the situation. Learn to differentiate normal reactions from those based on irrational beliefs.
Focus on events you can control. Don’t worry about things you cannot change or that may never happen; focus on strategies for handling events under your control.
View life as fluid. Expect change and accept it as inevitable; then many unanticipated changes will have less emotional impact.
Consider alternatives. Don’t rush into action; think before you act.
Set reasonable goals for yourself. Aim high, but be realistic about your capacities, motivation, and the situation.
Exercise regularly. A physically fit person can better handle stress, both physically and emotionally.
Master relaxation techniques. Relaxation helps refocus energies and reduce the physical discomfort of stress. Classes and self-help books teach these techniques.
Use constructive approaches to anger reduction. Delay responding (“Let me check into that and get back to you”); use mentally distracting behaviors (counting to 10 backwards) and self-instruction (a covert “Stop!”) to control anger arousal; then engage in calm, self-controlled problem solving (“I should call him rather than confront him personally”).
Seek social support. Friends, family members, co-workers, and organized support groups can offer information, assistance, and suggestions for coping with stressful situations.

As noted in  Chapter 13 , people tend to cope with stress more effectively as they move from early to middle adulthood. They may become more realistic about their ability to change situations and more skilled at anticipating stressful events and at preparing to manage them (Aldwin, Yancura, & Boeninger,  2010 ). Furthermore, when middle-aged adults surmount a highly stressful experience, they often report lasting personal benefits as they look back with amazement at what they were able to accomplish under extremely trying conditions. A serious illness and brush with death commonly brings changes in values and perspectives, such as clearer life priorities, a greater sense of personal strength, and closer ties to others. Interpreting trauma as growth-promoting is related to more effective coping with current stressors and with increased physical and mental health years later (Aldwin & Yancura,  2011 ; Carver,  2011 ). In this way, managing intense stress can serve as a context for positive development.

But for people who do have difficulty handling midlife’s challenges, communities provide fewer social supports than for young adults or senior citizens. For example, Jewel had little knowledge of what to expect during the climacteric. “It would have helped to have a support group so I could have learned about menopause and dealt with it more easily,” she told Trisha. Community programs addressing typical midlife concerns, such as those of adult learners returning to college and care-givers of elderly parents, can reduce stress during this period.

LOOK AND LISTEN

Interview a middle-aged adult who has overcome a highly stressful experience, such as a serious illness, about how he or she coped. Inquire about any resulting changes in outlook on life. Do the adult’s responses fit with research findings?

Exercise

Regular exercise, as noted in  Chapter 13 , has a range of physical and psychological benefits—among them, equipping adults to handle stress more effectively and reducing the risk of many diseases. Heading for his first aerobics class, Devin wondered, Can starting to exercise at age 50 counteract years of physical inactivity? His question is important: Nearly 70 percent of U.S. middle-aged adults are sedentary, and half of those who begin an exercise program discontinue it within the first six months. Even among those who stay active, fewer than 20 percent exercise at levels that lead to health benefits (U.S. Department of Health and Human Services,  2011c ).

A person beginning to exercise in midlife must overcome initial barriers and ongoing obstacles—lack of time and energy, inconvenience, work conflicts, and health factors (such as overweight). Self-efficacy—belief in one’s ability to succeed—is just as vital in adopting, maintaining, and exerting oneself in an exercise regimen as it is in career progress (see  Chapter 14 ). An important outcome of starting an exercise program is that sedentary adults gain in self-efficacy, which further promotes physical activity (McAuley & Elavsky,  2008 ; Wilbur et al.,  2005 ). Enhanced physical fitness, in turn, prompts middle-aged adults to feel better about their physical selves. Over time, their physical self-esteem—sense of body conditioning and attractiveness—rises (Elavsky & McAuley,  2007 ; Gothe et al.,  2011 ).

The exercise format that works best depends on the beginning exerciser’s characteristics. Normal-weight adults are more likely to stick with group classes than are overweight adults, who may feel embarrassed and struggle to keep up with the pace. Overweight people do better with an individualized, home-based routine planned by a consultant (King,  2001 ). However, adults with highly stressful lives are more likely to persist in group classes, which offer a regular schedule and the face-to-face support of others (King et al.,  1997 ). Yet when stressed people do manage to sustain a home-based program, it substantially reduces stress—more so than the group format (King, Taylor, & Haskell,  1993 ). Perhaps succeeding on their own helps stressed adults gain better control over their lives. A small digital monitor that tracks physical activity and gives feedback motivates inactive middle-aged adults to increase their activity levels (King et al.,  2008 ). And most say they enjoy using the device.

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In cities across the United States, barriers to physical activity are being overcome through the creation of attractive, safe parks and trails. But low-SES adults need greater access to convenient, pleasant exercise environments.

Accessible, attractive, and safe exercise environments—parks, walking and biking trails, and community recreation centers—and frequent opportunities to observe others using them also promote physical activity. Besides health problems and daily stressors, low-SES adults often mention inconvenient access to facilities, expense, unsafe neighborhoods, and unclean streets as barriers to exercise—important reasons that activity level declines sharply with SES (Taylor et al.,  2007 ; Wilbur et al.,  2003 ). Interventions aimed at increasing physical activity among low-SES adults must address these issues in addition to lifestyle and motivational factors.

An Optimistic Outlook

What type of individual is likely to cope adaptively with stress brought on by the inevitable changes of life? Researchers interested in this question have identified a set of three personal qualities—control, commitment, and challenge—that, together, they call  hardiness  (Maddi,  2005  2007  2011 ).

Trisha fit the pattern of a hardy individual. First, she regarded most experiences as controllable. “You can’t stop all bad things from happening,” she advised Jewel after hearing about her menopausal symptoms, “but you can try to do something about them.” Second, Trisha displayed a committed, involved approach to daily activities, finding interest and meaning in almost all of them. Finally, she viewed change as a challenge—a normal, welcome, even exciting part of life.

Hardiness influences the extent to which people appraise stressful situations as manageable, interesting, and enjoyable. These optimistic appraisals, in turn, predict health-promoting behaviors, tendency to seek social support, reduced physiological arousal to stress, and fewer physical and emotional symptoms (Maddi,  2006 ; Maruta et al.,  2002 ; Räikkönen et al.,  1999 ; Smith, Young, & Lee,  2004 ). Furthermore, high-hardy individuals are likely to use active, problem-centered coping strategies in situations they can control. In contrast, low-hardy people more often use emotion-centered and avoidant coping strategies—for example, saying, “I wish I could change how I feel,” denying that the stressful event occurred, or eating and drinking to forget about it (Maddi,  2007 ; Soderstrom et al.,  2000 ).

In this and previous chapters, we have seen that many factors act as stress-resistant resources—among them heredity, diet, exercise, social support, and coping strategies. Research on hardiness adds yet another ingredient: a generally optimistic outlook and zest for life.

Gender and Aging: A Double Standard

Negative stereotypes of aging, which lead many middle-aged adults to fear physical changes, are more likely to be applied to women than to men, yielding a double standard (Antonucci, Blieszner, & Denmark,  2010 ). Though many women in midlife say they have “hit their stride”—feel assertive, confident, versatile, and capable of resolving life’s problems—people often rate them as less attractive and as having more negative personality characteristics than middle-aged men (Canetto, Kaminski, & Felicio,  1995 ; Denmark & Klara,  2007 ; Kite et al.,  2005 ).

These effects appear more often when people rate photos as opposed to verbal descriptions of men and women. The ideal of a sexually attractive woman—smooth skin, good muscle tone, lustrous hair—may be at the heart of the double standard of aging. Some evidence suggests that the end of a woman’s ability to bear children contributes to negative judgments of physical appearance, especially by men (Marcus-Newhall, Thompson, & Thomas,  2001 ). Yet societal forces exaggerate this view. For example, middle-aged people in media ads are usually male executives, fathers, and grandfathers—handsome images of competence and security. And many more cosmetic products designed to hide signs of aging are offered for women than for men.

At one time in our evolutionary history, this double standard may have been adaptive. Today, as many couples limit childbearing and devote more time to career and leisure pursuits, it has become irrelevant. Some recent surveys suggest that the double standard is declining—that more people are viewing middle age as a potentially upbeat, satisfying time for both genders, sometimes even more so for women than for men (Menon,  2001 ; Narayan,  2008 ). Models of older women with lives full of intimacy, accomplishment, hope, and imagination are promoting acceptance of physical aging and a new vision of growing older—one that emphasizes gracefulness, fulfillment, and inner strength.

ASK YOURSELF

REVIEW Cite evidence that biological aging, individual heredity, and environmental factors contribute to osteoporosis.

CONNECT According to the lifespan perspective, development is multidimensional—affected by biological, psychological, and social forces. Provide examples of how this assumption characterizes health at midlife.

APPLY During a routine physical exam, Dr. Furrow gave 55-year-old Bill a battery of tests for cardiovascular disease but did not assess his bone density. In contrast, when 60-year-old Cara complained of chest pains, Dr. Furrow opted to “wait and see” before initiating further testing. What might account for Dr. Furrow’s different approaches to Cara and Bill?

REFLECT Which midlife health problem is of greatest personal concern to you? What steps can you take now to help prevent it?

COGNITIVE DEVELOPMENT

In middle adulthood, the cognitive demands of everyday life extend to new and sometimes more challenging situations. Consider a typical day in the lives of Devin and Trisha. Recently appointed dean of faculty at a small college, Devin was at his desk by 7:00 A.M. In between strategic-planning meetings, he reviewed files of applicants for new positions, worked on the coming year’s budget, and spoke at an alumni luncheon. Meanwhile, Trisha prepared for a civil trial, participated in jury selection, and then joined the other top lawyers at her firm for a conference about management issues. That evening, Trisha and Devin advised their 20-year-old son, Mark, who had dropped by to discuss his uncertainty over whether to change his college major. By 7:30 P.M., Trisha was off to an evening meeting of the local school board. And Devin left for a biweekly gathering of an amateur quartet in which he played the cello.

Middle adulthood is a time of expanding responsibilities—on the job, in the community, and at home. To juggle diverse roles effectively, Devin and Trisha called on a wide array of intellectual abilities, including accumulated knowledge, verbal fluency, memory, rapid analysis of information, reasoning, problem solving, and expertise in their areas of specialization. What changes in thinking take place in middle adulthood? How does vocational life—a major arena in which cognition is expressed—influence intellectual skills? And what can be done to support the rising tide of adults who are returning to higher education in hopes of enhancing their knowledge and quality of life?

image17 Changes in Mental Abilities

At age 50, when he occasionally couldn’t recall a name or had to pause in the middle of a lecture or speech to think about what to say next, Devin wondered, Are these signs of an aging mind? Twenty years earlier, he had taken little notice of the same events. His questioning stems from widely held stereotypes of older adults as forgetful and confused. Most cognitive aging research has focused on deficits while neglecting cognitive stability and gains.

As we examine changes in thinking in middle adulthood, we will revisit the theme of diversity in development. Different aspects of cognitive functioning show different patterns of change. Although declines occur in some areas, most people display cognitive competence, especially in familiar contexts, and some attain outstanding accomplishment. As we will see, certain apparent decrements in cognitive aging result from weaknesses in the research itself! Overall, the evidence supports an optimistic view of adult cognitive potential.

The research we are about to consider illustrates core assumptions of the lifespan perspective: development as multidimensional, or the combined result of biological, psychological, and social forces; development as multidirectional, or the joint expression of growth and decline, with the precise mix varying across abilities and individuals; and development as plastic, or open to change, depending on how a person’s biological and environmental history combines with current life conditions. You may find it helpful to return to  pages 9  10  in  Chapter 1  to review these ideas.

Cohort Effects

Research using intelligence tests sheds light on the widely held belief that intelligence inevitably declines in middle and late adulthood as the brain deteriorates. Many early cross-sectional studies showed this pattern—a peak in performance at age 35 followed by a steep drop into old age. But widespread testing of college students and soldiers in the 1920s provided a convenient opportunity to conduct longitudinal research, retesting participants in middle adulthood. These findings revealed an age-related increase! To explain this contradiction, K. Warner Schaie ( 1998 , 2005) used a sequential design, combining longitudinal and cross-sectional approaches (see  page 38  in  Chapter 1 ) in the Seattle Longitudinal Study.

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FIGURE 15.4 Cross-sectional and longitudinal trends in verbal ability, illustrating cohort effects.

The steep cross-sectional decline is largely due to better health and education in younger generations. When adults are followed longitudinally, their verbal scores rise during early and middle adulthood and gradually decline during later years. However, this longitudinal trend does not hold for all abilities.

(From K. W. Schaie, 1988, “Variability in Cognitive Functioning in the Elderly,” in M. A. Bender, R. C. Leonard, & A. D. Woodhead [Eds.], Phenotypic Variation in Populations, p. 201. Adapted with kind permission from Springer Science+Business Media B. V. and K. W. Schaie.)

In 1956, people ranging in age from 22 to 70 were tested cross-sectionally. Then, at regular intervals, longitudinal follow-ups were conducted and new samples added, yielding a total of 5,000 participants, five cross-sectional comparisons, and longitudinal data spanning more than 60 years. Findings on five mental abilities showed the typical cross-sectional drop after the mid-thirties. But longitudinal trends for those abilities revealed modest gains in midlife, sustained into the fifties and the early sixties, after which performance decreased gradually.

Figure 15.4  illustrates Schaie’s cross-sectional and longitudinal outcomes for just one intellectual factor: verbal ability. How can we explain the seeming contradiction in findings? Cohort effects are largely responsible for this difference. In cross-sectional research, each new generation experienced better health and education than the one before it (Schaie,  2011 ). Also, the tests given may tap abilities less often used by older individuals, whose lives no longer require that they learn information for its own sake but, instead, skillfully solve real-world problems.

Crystallized and Fluid Intelligence

A close look at diverse mental abilities shows that only certain ones follow the longitudinal pattern identified in  Figure 15.4 . To appreciate this variation, let’s consider two broad mental abilities, each of which includes an array of specific intellectual factors.

The first of these broad abilities,  crystallized intelligence , refers to skills that depend on accumulated knowledge and experience, good judgment, and mastery of social conventions—abilities acquired because they are valued by the individual’s culture. Devin made use of crystallized intelligence when he expressed himself articulately at the alumni luncheon and suggested effective ways to save money in budget planning. On intelligence tests, vocabulary, general information, verbal comprehension, and logical reasoning items measure crystallized intelligence.

In contrast,  fluid intelligence  depends more heavily on basic information-processing skills—ability to detect relationships among visual stimuli, speed of analyzing information, and capacity of working memory. Though fluid intelligence often combines with crystallized intelligence to support effective reasoning and problem solving, it is believed to be influenced less by culture than by conditions in the brain and by learning unique to the individual (Horn & Noll,  1997 ). Intelligence test items reflecting fluid abilities include spatial visualization, digit span, letter–number sequencing, and symbol search. (Refer to  page 302  in  Chapter 9  for examples.)

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Don Clarke, who flew attack helicopters in the U.S. army, fulfilled a long-held dream when he became an emergency medical service helicopter pilot. Flying search-and-rescue missions requires Clarke, now in his early sixties, to make use of complex mental abilities that are at their peak in midlife.

Many cross-sectional studies show that crystallized intelligence increases steadily through middle adulthood, whereas fluid intelligence begins to decline in the twenties. These trends have been found repeatedly in investigations in which younger and older participants had similar education and general health status, largely correcting for cohort effects (Horn, Donaldson, & Engstrom,  1981 ; Kaufman & Horn,  1996 ; Park et al.,  2002 ). In one such investigation, including nearly 2,500 mentally and physically healthy 16- to 85-year-olds, verbal (crystallized) IQ peaked between ages 45 and 54 and did not decline until the eighties! Nonverbal (fluid) IQ, in contrast, dropped steadily over the entire age range (Kaufman,  2001 ).

The midlife rise in crystallized abilities makes sense because adults are constantly adding to their knowledge and skills at work, at home, and in leisure activities. In addition, many crystallized skills are practiced almost daily. But does longitudinal evidence confirm the progressive falloff in fluid intelligence? And if so, how can we explain it?

Schaie’s Seattle Longitudinal Study.

Figure 15.5  shows Schaie’s longitudinal findings in detail. The five factors that gained in early and middle adulthood—verbal ability, inductive reasoning, verbal memory, spatial orientation, and numeric ability—include both crystallized and fluid skills. Their paths of change confirm that midlife is a time when some of the most complex mental abilities are at their peak (Willis & Schaie,  1999 ). According to these findings, middle-aged adults are intellectually “in their prime,” not—as stereotypes would have it—“over the hill.”

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Figure 15.5 Longitudinal trends in six mental abilities, from the seattle longitudinal study.

In five abilities, modest gains occurred into the fifties and early sixties, followed by gradual declines. The sixth ability—perceptual speed—decreased steadily from the twenties to the late eighties. And late in life, fluid factors (spatial orientation, numeric ability, and perceptual speed) showed greater decrements than crystallized factors (verbal ability, inductive reasoning, and verbal memory).

(From K. W. Schaie, 1994, “The Course of Adult Intellectual Development,” American Psychologist, 49, p. 308. Copyright © 1994 by the American Psychological Association. Reprinted with permission of American Psychological Association.)

Figure 15.5  also shows a sixth ability, perceptual speed—a fluid skill in which participants must, for example, identify within a time limit which of five shapes is identical to a model or whether pairs of multidigit numbers are the same or different. Perceptual speed decreased from the twenties to the late eighties—a pattern that fits with a wealth of research indicating that cognitive processing slows as people get older (Schaie,  1998  2005 ). Also notice in  Figure 15.5  how, late in life, fluid factors (spatial orientation, numeric ability, and perceptual speed) show greater decrements than crystallized factors (verbal ability, inductive reasoning, and verbal memory). These trends have been confirmed in short-term longitudinal follow-ups of individuals varying widely in age (McArdle et al.,  2002 ).

Explaining Changes in Mental Abilities.

Some theorists believe that a general slowing of central nervous system functioning underlies nearly all age-related declines in cognitive performance (Salthouse,  1996  2006 ). Many studies offer at least partial support for this idea. For example, Kaufman ( 2001 ) reported that scores on speeded tasks mirror the regular, age-related decline in fluid-task performance. Researchers have also identified other important changes in information processing, some of which may be triggered by declines in speed.

Before we turn to this evidence, let’s clarify why research reveals gains followed by stability in crystallized abilities, despite a much earlier decline in fluid intelligence, or basic information-processing skills. First, the decrease in basic processing, while substantial after age 45, may not be great enough to affect many well-practiced performances until quite late in life. Second, as we will see, adults can often compensate for cognitive limitations by drawing on their cognitive strengths. Finally, as people discover that they are no longer as good as they once were at certain tasks, they accommodate, shifting to activities that depend less on cognitive efficiency and more on accumulated knowledge. Thus, the basketball player becomes a coach, the once quick-witted salesperson a manager.

Individual and Group Differences

The age trends just described mask large individual differences. Some adults, because of illness or unfavorable environments, decline intellectually much earlier than others. And others sustain high functioning, even in fluid abilities, at advanced ages.

Adults who use their intellectual skills seem to maintain them longer. In the Seattle Longitudinal Study, declines were delayed for people with above-average education; complex, self-directed occupations; and stimulating leisure pursuits that included reading, traveling, attending cultural events, and participating in clubs and professional organizations. People with flexible personalities, lasting marriages (especially to a cognitively high-functioning partner), and absence of cardiovascular and other chronic diseases were also likely to maintain mental abilities well into late adulthood (Schaie,  1996 , 2000,  2011 ; Yu et al.,  2009 ). And being economically well-off was linked to favorable cognitive development, undoubtedly because SES is associated with many of the factors just mentioned.

Several sex differences also emerged, consistent with those found in childhood and adolescence. In early and middle adulthood, women outperformed men on verbal tasks and perceptual speed, while men excelled at spatial skills (Maitland et al.,  2000 ). Overall, however, changes in mental abilities over the adult years were remarkably similar for the two sexes, defying the stereotype that older women are less competent than older men.

Furthermore, when the baby-boom generation, now middle-aged, was compared with the previous generation at the same age, cohort effects were evident. On verbal memory, inductive reasoning, and spatial orientation, baby boomers performed substantially better, reflecting generational advances in education, technology, environmental stimulation, and health care (Schaie,  2011 ; Willis & Schaie,  1999 ). These gains are expected to continue: Today’s children, adolescents, and adults of all ages attain substantially higher mental test scores than same-age individuals born just a decade or two earlier—differences that are largest for fluid-ability tasks (Flynn,  2007  2011 ; Zelinski & Kennison,  2007 ).

Finally, adults who maintained higher levels of perceptual speed tended to be advantaged in other cognitive capacities. As we turn to information processing in midlife, we will pay special attention to the impact of processing speed on other aspects of cognitive functioning.

image21 Information Processing

Many studies confirm that as processing speed slows, certain basic aspects of executive function, including attention and working memory, decline. Yet midlife is also a time of great expansion in cognitive competence as adults apply their vast knowledge and life experience to problem solving in the everyday world.

Speed of Processing

Devin watched with fascination as his 20-year-old son, Mark, played a computer game, responding to multiple on-screen cues in rapid-fire fashion. When Devin tried it, though he practiced over several days, his performance remained well behind Mark’s. Similarly, on a family holiday in Australia, Mark adjusted quickly to driving on the left side of the road, but after a week, Trisha and Devin still felt confused at intersections, where rapid responses were needed.

These real-life experiences fit with laboratory findings. On both simple reaction-time tasks (pushing a button in response to a light) and complex ones (pushing a left-hand button to a blue light, a right-hand button to a yellow light), response time increases steadily from the early twenties into the nineties. The more complex the situation, the more disadvantaged older adults are. Although the decline in speed is gradual and quite small—less than 1 second in most studies—it is nevertheless of practical significance (Der & Deary,  2006 ; Dykiert et al.,  2012 ).

What causes this age-related slowing of cognitive processing? Researchers agree that changes in the brain are responsible but disagree on the precise explanation (Hartley,  2006 ; Salthouse & Caja,  2000 ). According to the  neural network view , as neurons in the brain die, breaks in neural networks occur. The brain adapts by forming bypasses—new synaptic connections that go around the breaks but are less efficient(Cerella,  1990 ). In support of this hypothesis, aging is accompanied by withering of the myelin coating on neural fibers within the cerebral cortex, especially in the frontal lobes and the corpus callosum. Reduced myelination appears as small, high-intensity bright spots within fMRIs (Raz et al.,  2007 ). The bright spots, a sign of deteriorating neuronal connections, are believed to be caused by reduced cerebral blood flow (often associated with high blood pressure and atherosclerosis). Extent of myelin breakdown, however, does not consistently predict decrements in reaction time or other cognitive functions (Rodrigue & Kennedy,  2011 ).

Another approach to age-related cognitive slowing, the  information-loss view , suggests that older adults experience greater loss of information as it moves through the cognitive system. As a result, the whole system must slow down to inspect and interpret the information. Imagine making a photocopy, then using it to make another copy. Each subsequent copy is less clear. Similarly, with each step of thinking, information degrades. The older the adult, the more exaggerated this effect (Myerson et al.,  1990 ). Complex tasks, which have more processing steps, are more affected by information loss. Possibly, multiple neural changes that vary across individuals underlie such information loss and associated declines in processing speed (Hartley,  2006 ; Salthouse,  2011 ).

What is clear is that processing speed predicts adults’ performance on many tests of complex abilities. The slower their reaction time, the lower people’s scores on tests of memory, reasoning, and problem solving, with relationships greater for fluid- than crystallized-ability items (Finkel et al.,  2007 ; Salthouse,  2006 ). Indeed, as adults get older, correlations between processing speed and other cognitive performances strengthen (see  Figure 15.6 ). This suggests that processing speed contributes broadly to declines in cognitive functioning, which become more widespread and pronounced with aging (Li et al.,  2004 ).

Yet as  Figure 15.6  shows, processing speed correlates only moderately with older adults’ performances, including fluid-ability tasks. And it is not the only major predictor of age-related cognitive changes. Other factors—declines in vision and hearing and in attentional resources, inhibition, working-memory capacity, and use of memory strategies—also predict diverse age-related cognitive performances (Hartley,  2006 ; Luo & Craik,  2008 ). Nevertheless, processing speed, as we will see in the following sections, does contribute to the decrements in attention and memory just mentioned (Levitt, Fugelsang, & Crossley,  2006 ). But disagreement persists over whether age-related cognitive changes have just one common cause, best represented by processing speed, or multiple independent causes.

Furthermore, processing speed is a weak predictor of the skill with which older adults perform complex, familiar tasks in everyday life, which they continue to do with considerable proficiency. Devin, for example, played a Mozart quartet on his cello with great speed and dexterity, keeping up with three other players 10 years his junior. How did he manage? Compared with the others, he more often looked ahead in the score (Krampe & Charness,  2007 ). Using this compensatory approach, he could prepare a response in advance, thereby minimizing the importance of speed. In one study, researchers asked 19- to 72-year-olds to perform a variety of typing tasks and also tested their reaction time. Although reaction time slowed with age, typing speed did not change (Salthouse,  1984 ). Like Devin, older typists look further ahead in the material to be typed, anticipating their next keystrokes. Knowledge and experience can also compensate for impairments in processing speed. Devin’s many years of playing the cello undoubtedly supported his ability to play swiftly and fluidly.

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FIGURE 15.6 Age-related changes in correlations of processing speed with measures of fluid and crystallized intelligence.

Correlations are higher at younger and at older ages. During childhood, gains in processing speed support development of other abilities and are related to mental test performance (see  Chapter 9  page 302 ). As people age, declines in processing speed limit many abilities, but more so for fluid than crystallized skills. Note, however, that even at the oldest ages, correlations between processing speed and other abilities are moderate.

(From S.-C. Li et al., 2004, “Transformations in the Couplings Among Intellectual Abilities and Constituent Cognitive Processes Across the Life Span,” Psychological Science, 15, p. 160. Copyright © 2004, Sage Publications. Reprinted by Permission of SAGE Publications.)

Because older adults find ways to compensate for cognitive slowing on familiar tasks, their reaction time is considerably better on verbal items (indicating as quickly as possible whether a string of letters forms a word) than on nonverbal items (responding to a light or other signal) (Hultsch, MacDonald, & Dixon,  2002 ; Verhaeghen & Cerella,  2008 ). Finally, as we will see in  Chapter 17 , older adults’ processing speed can be improved through training, though age differences remain.

Attention

Studies of attention focus on how much information adults can take into their mental systems at once; the extent to which they can attend selectively, ignoring irrelevant information; and the ease with which they can adapt their attention, switching from one task to another as the situation demands. When Dottie telephoned, Trisha sometimes tried to prepare dinner or check her e-mail inbox while talking on the phone. But with age, she found it harder to engage in the two activities simultaneously.

Consistent with Trisha’s experience, laboratory research reveals that sustaining two tasks at once, when at least one of the tasks is complex, becomes more challenging with age. Older adults have difficulty even when they have recently engaged in extensive practice of one of the activities and it is therefore expected to be automatic (Maquestiaux et al.,  2010 ). An age-related decrement also occurs in the ability to focus on relevant information and to switch back and forth between mental operations, such as judging one of a pair of numbers as “odd or even” on some trials, “more or less” on others (Kramer & Kray,  2006 ; Verhaeghen & Cerella,  2008 ).

These declines in attention might be due to the slowdown in information processing described earlier, which limits the amount of information a person can focus on at once (Allen, Ruthruff, & Lien,  2007 ; Verhaeghen,  2012 ). Reduced processing speed may also contribute to a related finding: a decrement with age in the ability to combine many pieces of visual information into a meaningful pattern. When the mind inspects stimuli slowly, they are more likely to remain disconnected (Pilz, Bennett, & Sekuler,  2010 ; Plude & Doussard-Roosevelt,  1989 ). This problem, in turn, can intensify attentional difficulties.

As adults get older, inhibition—resistance to interference from irrelevant information—is also harder (Gazzaley et al.,  2005 ; Hasher, Lustig, & Zacks,  2007 ). On continuous performance tasks, in which participants are shown a series of stimuli on a computer screen and asked to press the space bar only after a particular sequence occurs (for example, the letter K immediately followed by the letter A), performance declines steadily from the thirties into old age, with older adults making more errors of commission (pressing the space bar in response to incorrect letter sequences). And when extraneous noise is introduced, errors of omission (not pressing the space bar after a K–A sequence) also rise with age (Mani, Bedwell, & Miller,  2005 ). In everyday life, inhibitory difficulties cause older adults to appear distractible—inappropriately diverted from the task at hand by a thought or a feature of the environment.

Again, adults can compensate for these changes. People highly experienced in attending to critical information and performing several tasks at once, such as air traffic controllers and pilots, know exactly what to look for. As a result, they show smaller age-related attentional declines (Tsang & Shaner,  1998 ). Similarly, older adults focus on relevant information and handle two tasks proficiently when they have extensively practiced those activities over their lifetimes (Kramer & Madden,  2008 ).

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Conductors and teachers must focus on relevant information within a complex field of stimulation and divide their attention among competing tasks—well-practiced skills that may help slow age-related declines in attention.

Finally, practice can improve the ability to divide attention between two tasks, selectively focus on relevant information, and switch back and forth between mental operations. When older adults receive training in these skills, their performance improves as much as that of younger adults, although training does not close the gap between age groups (Bherer et al.,  2006 ; Erickson et al.,  2007 ; Kramer, Hahn, & Gopher,  1998 ).

Memory

Memory is crucial for all aspects of information processing—an important reason that we place great value on a good memory in middle and late adulthood. From the twenties into the sixties, the amount of information people can retain in working memory diminishes. Whether given lists of words or digits (verbal tasks) or serial location stimuli (spatial tasks involving retaining each location on a screen of a series of stimuli), middle-aged and older adults recall less than young adults, although verbal memory suffers much less than spatial memory (Hale et al.,  2011 ; Old & Naveh-Benjamin,  2008a ). Verbal memory may be better preserved because the older adults tested have previously formed and often used verbal representations of the to-be-learned information (Kalpouzos & Nyberg,  2012 ). The necessary spatial representations, in contrast, are far less familiar.

These changes are affected by a decline in use of memory strategies. Older individuals rehearse less than younger individuals—a difference believed to be due to a slower rate of thinking (Salthouse,  1996 ). Older people cannot repeat new information to themselves as quickly as younger people. A reduction in basic working-memory capacity is another influence, leading to difficulties in retaining to-be-remembered items and processing them at the same time (Basak & Verhaeghen,  2011 ).

Memory strategies of organization and elaboration, which require people to link incoming information with already stored information, are also applied less often and less effectively with age (Dunlosky & Hertzog,  2001 ; Troyer et al.,  2006 ). An additional reason older adults are less likely to use these techniques is that they find it harder to retrieve information from long-term memory that would help them recall. For example, given a list of words containing parrot and blue jay, they don’t immediately access the category “bird,” even though they know it well (Hultsch et al.,  1998 ). Why does this happen? Greater difficulty keeping one’s attention on relevant information seems to be involved (Hasher, Lustig, & Zacks,  2007 ). As irrelevant stimuli take up space in working memory, less is available for the memory task at hand.

But keep in mind that the memory tasks given by researchers require strategies that many adults seldom use and may not be motivated to use, since most are not in school (see  Chapter 9  page 306 ). When a word list has a strong category-based structure, older adults organize as well as younger adults do (Naveh-Benjamin,  2000 ; Naveh-Benjamin et al.,  2005 ). And when given training in strategic memorizing, middle-aged and older people use strategies willingly, and they show improved performance over long periods, though age differences remain (Derwinger, Neely, & Bäckman,  2005 ).

Furthermore, tasks can be designed to help older people compensate for age-related declines in working memory—for example, by slowing the pace at which information is presented or cuing the link between new and previously stored information (“To learn these words, try thinking of the category ‘bird’”) (Hay & Jacoby,  1999 ). In one study, adults ranging in age from 19 to 68 were shown a video and immediately tested on its content (a pressured, classroomlike condition). Then they were given a packet of information on the same topic as the video to study at their leisure and told to return three days later to be tested (a self-paced condition) (Beier & Ackerman,  2005 ). Performance declined with age only in the pressured condition, not in the self-paced condition. And although topic-relevant knowledge predicted better recall in both conditions, it did so more strongly in the self-paced condition, which granted participants ample time to retrieve and apply what they already knew.

LOOK AND LISTEN

Ask several adults in their fifties or early sixties to list their top three everyday memory challenges and to explain what they do to enhance recall. How knowledgeable are these midlifers about effective memory strategies?

As these findings illustrate, assessing older adults in highly structured, constrained conditions substantially underestimates what they can remember when given opportunities to pace and direct their own learning. (Refer to the Social Issues: Education box on the following page for a “dramatic” illustration.) When we consider the variety of memory skills we call on in daily life, the decrements just described are limited in scope. General factual knowledge (such as historical events), procedural knowledge (such as how to drive a car or solve a math problem), and knowledge related to one’s occupation either remain unchanged or increase into midlife.

Social Issues: Education The Art of Acting Improves Memory in Older Adults

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These community-theater actors master their lines through deep, elaborate processing of goal-oriented segments of dialogue. Teaching these script-learning techniques to aging adults yields lasting gains in memory performance.

Actors face a daunting task: They must memorize massive quantities of dialogue and then reproduce it accurately and spontaneously, as if they genuinely mean what they say. No wonder the most common question asked of actors is, “How did you learn all those lines?”

Interviews with professional actors reveal that most don’t memorize lines in the way students typically learn a historic speech or a poem in school—by rote, or rehearsing the lines many times. Instead, they focus on the meaning of the words, an approach that produces much better recall. First, they analyze the script for the character’s intentions, breaking it down into what they call “beats”—small, goal-directed chunks of dialogue. Then they represent the role as a sequence of goals, one leading to the next. When actors recall this chain of goals, lines become easier to remember (Noice & Noice,  2006 ). For example, one actor divided a half-page of dialogue into three beats: “to put [the other character] at ease,” “to start a conversation with him,” “to flatter/draw him out.”

To create a beat sequence, actors engage in extensive elaboration of dialogue segments. For example, to the line, “Perhaps he’s in love with me but doesn’t know it,” an actor might create a visual image of an uncertain lover, relate the material to a past love affair of her own, and match her own mood to feeling tone of the statement. Deep elaborative processing of the dialogue segment, along with analysis of its beat goal, yields substantial verbatim recall without rote memorization.

Actors’ script learning is so successful that on stage, they are free to “live in the moment,” focusing on communicating authentic meaning through action, emotion, and utterance while speaking verbatim lines. This intermodal integration of spoken word with facial expression, tone of voice, and body language contributes further to script retention.

Can aging adults benefit from exercises that teach the essence of acting—thorough mastery of a script, enabling complete immersion in performance? To find out, researchers gave middle-aged and older adults nine 90-minute cognitively demanding group sessions of theater training over a month’s time. Each session required them to analyze the goals of brief scenes so they could become fully engrossed in acting out their meaning (Noice, Noice, & Staines,  2004 ). Compared with no-intervention controls, theater-training participants showed greater gains on tests of working-memory capacity, word recall, and problem solving—improvements still evident four months after the intervention ended.

The theater training required highly effortful intermodal processing, which may explain its cognitive benefits. fMRI research indicates that deeply processing verbal meanings strongly activates certain areas in the frontal lobes of the cerebral cortex in middle-aged adults, restoring them to patterns close to those of young adults (Park,  2002 ). These findings lend neurobiological support to the power of acting, with its challenging intermodal processing of meaning, to enhance human memory.

Furthermore, middle-aged people who have trouble recalling something often draw on decades of accumulated metacognitive knowledge about how to maximize memory—reviewing major points before an important presentation, organizing notes and files so information can be found quickly, and parking the car in the same area of the parking lot each day. Research confirms that aging has little impact on metacognitive knowledge and the ability to apply such knowledge to improve learning (Hertzog & Dunlosky  2011 ; Schwartz & Frazier,  2005 ).

In sum, age-related changes in memory vary widely across tasks and individuals as people use their cognitive capacities to meet the requirements of their everyday worlds.  TAKE A MOMENT…  Does this remind you of Sternberg’s theory of successful intelligence, described in  Chapter 9 —in particular, his notion of practical intelligence (see  page 311 )? Intelligent people adapt their information-processing skills to fit with their personal desires and the demands of their environments. Therefore, to understand memory development (and other aspects of cognition) in adulthood, we must view it in context. As we turn to problem solving, expertise, and creativity, we will encounter this theme again.

Practical Problem Solving and Expertise

One evening, as Devin and Trisha sat in the balcony of the Chicago Opera House awaiting curtain time, the announcement came that 67-year-old Ardis Krainik, the opera company’s general director and “life force,” had died. After a shocked hush, members of the audience began turning to one another, asking about the woman who had made the opera company into one of the world’s greatest.

Starting as a chorus singer and clerk typist, Ardis rose rapidly through the ranks, becoming assistant to the director and developing a reputation for tireless work and unmatched organizational skill. When the opera company fell deeply in debt, Ardis—now the newly appointed general director—erased the deficit within a year and restored the company’s sagging reputation. She charmed donors into making large contributions, attracted world-class singers, and filled the house to near capacity.

Ardis’s story is a dramatic one, but all middle-aged adults encounter opportunities to display continued cognitive growth in the realm of  practical problem solving , which requires people to size up real-world situations and analyze how best to achieve goals that have a high degree of uncertainty. Gains in expertise—an extensive, highly organized, and integrated knowledge base that can be used to support a high level of performance—help us understand why practical problem solving takes this leap forward.

The development of expertise is under way in early adulthood and reaches its height in midlife, leading to highly efficient and effective approaches to solving problems that are organized around abstract principles and intuitive judgments. Saturated with experience, the expert intuitively feels when an approach to a problem will work and when it will not. This rapid, implicit application of knowledge is the result of years of learning, experience, and effortful practice (Birney & Sternberg,  2006 ; Krampe & Charness,  2007 ). It cannot be assessed by laboratory tasks or mental tests that do not call on this knowledge.

Expertise is not just the province of the highly educated and of those who rise to the top of administrative ladders. In a study of food service workers, researchers identified the diverse ingredients of expert performance in terms of physical skills (strength and dexterity); technical knowledge (of menu items, ordering, and food presentation); organizational skills (setting priorities, anticipating customer needs); and social skills (confident presentation and a pleasant, polished manner). Next, 20- to 60-year-olds with fewer than two to more than ten years of experience were evaluated on these qualities. Although physical strength and dexterity declined with age, job knowledge and organizational and social skills increased (Perlmutter, Kaplan, & Nyquist,  1990 ). Compared to younger adults with similar years of experience, middle-aged employees performed more competently, serving customers in especially adept, attentive ways.

Age-related advantages are also evident in solutions to everyday problems (Denney,  1990 ; Denney & Pearce,  1989 ).  TAKE A MOMENT…  Consider the following dilemma:

·  What would you do if you had a landlord who refused to make some expensive repairs you want done because he or she thinks they are too costly?

· a. Try to make the repairs yourself.

· b. Try to understand your landlord’s view and decide whether they are necessary repairs.

· c. Try to get someone to settle the dispute between you and your landlord.

· d. Accept the situation and don’t dwell on it. (Cornelius & Caspi,  1987 , p. 146)

In this example, the preferred choice is (b), a problem-centered approach that involves seeking information and using it to guide action. From middle age on, adults place greater emphasis on thinking through a practical problem with multiple potential solutions—trying to understand it better, interpreting it from different perspectives, and solving it through logical analysis. On such tasks, middle-aged and older adults select strategies that (as rated by independent judges) are at least as good as and sometimes better than those of young adults (Kim & Hasher,  2005 ; Mienaltowski,  2011 ). Perhaps for this reason, they are more rational decision makers—less likely than young adults to select attractive-looking options that, on further reflection, are not the best.

Creativity

As noted in  Chapter 13 , creative accomplishment tends to peak in the late thirties or early forties and then decline, but with considerable variation across individuals and disciplines. Some people produce highly creative works in later decades: In her early sixties, Martha Graham choreographed Clytemnestra, recognized as one of the great full-length modern-dance dramas. Igor Stravinsky composed his last major musical work at age 84. Charles Darwin finished On the Origin of Species at age 50 and continued to write groundbreaking books and papers in his sixties and seventies. Harold Gregor, who painted the dazzling image on the cover of this book, continues to invent new styles and to be a highly productive artist at age 83. And as with problem solving, the quality of creativity may change with advancing age—in at least three ways.

First, youthful creativity in literature and the arts is often spontaneous and intensely emotional, while creative works produced after age 40 often appear more deliberately thoughtful (Lubart & Sternberg,  1998 ). Perhaps for this reason, poets produce their most frequently cited works at younger ages than do authors of fiction and nonfiction (Cohen-Shalev,  1986 ). Poetry depends more on language play and “hot” expression of feelings, whereas story- and book-length works require extensive planning and molding.

Second, with age, many creators shift from generating unusual products to combining extensive knowledge and experience into unique ways of thinking (Abra,  1989 ; Sasser-Coen,  1993 ). Creative works by older adults more often sum up or integrate ideas. Mature academics typically devote less energy to new discoveries in favor of writing memoirs, histories of their field, and other reflective works. And in older creators’ novels, scholarly writings, and commentaries about their paintings and musical compositions, learning from life experience and living with old age are common themes (Beckerman,  1990 ; Lindauer, Orwoll, & Kelley,  1997 ; Sternberg & Lubart,  2001 ).

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In midlife, creativity often shifts to more altruistic goals. Author Masha Hamilton’s travels to northeastern Kenya to research her novel, The Camel Bookmobile, led her to help organize the Camel Book Drive. It has funded the purchase of camels, books, and equipment for nomadic schools in the area.

Finally, creativity in middle adulthood frequently reflects a transition from a largely egocentric concern with self-expression to more altruistic goals (Tahir & Gruber,  2003 ). As the middle-aged person overcomes the youthful illusion that life is eternal, the desire to give to humanity and enrich the lives of others increases.

Taken together, these changes may contribute to an overall decline in creative output in later decades. In reality, however, creativity takes new forms.

Information Processing in Context

Cognitive gains in middle adulthood are especially likely in areas involving experience-based buildup and transformation of knowledge and skills. As the evidence just reviewed confirms, processing speed varies with the situation. When given challenging real-world problems related to their expertise, middle-aged adults are likely to win out in both efficiency and excellence of thinking. Furthermore, on tasks and test items relevant to their real-life endeavors, intelligent, cognitively active midlifers respond as competently an

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