Health Problems in Late Adulthood

Late adulthood is a period where health generally declines along with deteriorating physical conditions. However, in recent decades due to advances in medical sciences the general health of elderly individuals has increased to a considerable extent. Health in late adulthood is influenced by many factors some of these include use of antibiotic, educational level, socio-cultural factors, dietary restrictions and physical exercises. Following are the important points to be noted with regard to the health problems in late adulthood. Overall, older people need more medial care than younger ones. They go to the doctor more often, are hospitalized more frequently stay in the hospital longer, and spend more than 4 times as much money on health care. Although most elderly people are in good health, chronic medical conditions do become more frequent with age and may cause disability. Older people have at least one chronic condition: the most common are arthritis (48 percent); hypertension (37 percent); heart disease (30 percent); cataract (16 percent); hearing impairments (30 percent); and impairments of the leg, hips, back, or spine (17 percent). But people over 65 have fewer colds, flue infections, and acute digestive problems than younger adults. The danger with older people is that a minor illness-along with chronic conditions and loss of reserve capacity – may have serious repercussions. Susceptibility to illness is one of the mot serious problems confronting older persons. This is generally the case in chronic conditions. Most people over 65 years suffer from one or more chronic conditions. The most common chronic conditions restricting activity in late adulthood especially in individuals over 65 years are heart diseases, arthritis, hypertension, visual impairment and orthopedic problems. Another common problem of late adulthood is the dental problems, especially to tooth decay. This effects digestion and leads to many other problems. Many elderly people suffer from a wide variety of functional disorders. The most common functional disorders in the elderly include depression, paranoid reactions, hypochondriacs, and chronic anxiety (Butler & Lewis, 1977; Pfeffer. 1977). Of these, depressive reactions are the most frequent and are characterized by extreme sadness, social withdrawal, inhibition, lowered self-esteem, pessimism, indecision, and occasionally, a slowing down of mental processes as well as physical movement. The suicide rate for the elderly, which is linked to depression, is higher than for any other age group especially for white males. It is estimated that some 1 to 2 percent of elderly people living in the community suffer from major depression, another 2 percent have less severe depression, and more than 10 percent have some important symptoms (Blazer, 1989). Organic brain syndrome is another major problem faced by individuals in late adulthood. The two most common organic brain syndromes associated with aging are cerebral arteriosclerosis and senile dementia Cerebral arteriosclerosis is related to increased arterial cholesterol levels – as the arteries “harden” blood flow to the brain is reduced and localized brain death occurs. Initially, mood or affect changes are noted, as well as increased irritability, fatigue, and headaches. As the condition progresses, cognitive process are affected especially memory, abstraction ability, and assimilation of new information. The onset of this disease, which more often affects men than women may occur as early as the mid-fifties. Senile dementia, on the other hand, begins much later in life, usually in the mid-seventies, and is more often found in females than males -probably because women live longer than men. This condition is associated with diffuse or general brain loss of unknown origin. Over the course of the disease brain weight can reduce as much as 15 to 30 percent. Typical symptoms include errors in intellectual and social judgment, mood changes, memory impairment spatial and temporal disorientation, general confusion, loosening of inhibitions, and deterioration of personal habits. Both cerebral arteriosclerosis and senile dementia are chronic conditions; full recovery from them is not possible, although improvement can be obtained as times with proper medical treatment. Many individual in late adulthood also suffer from irreversible mental problems. The most common irreversible mental problem is Alzheimer’s disease. It is a degenerative brain disorder that gradually robs people of intelligence, awareness, and even the ability to control they bodily functions and finally kills them.

This malady, the most prevalent and most feared irreversible dementia, occasionally strikes in middle age, but most of its victims are over 65. Estimates of its prevalence very from 6 to 10 percent of all people and over 65 and from 20 to 50 percent of all people over 85. In late adulthood there is a slowing down of the control nervous system. This lead to memory losses and difficulties in memory retrieval and learning. Scores on intelligence test also declines. A wide variety of mental changes occur in late adulthood which is generally detrimental. Some of these mental changes are as follows:

Learning is slow in them:

Inductive and deductive reasoning slows down. Older people tend to lack the capacity for, or interest in, creative thinking. Thus significant creative achievement is less common among older people than among younger ones. Old people tend to have poor recent memories but better remote memories. Mental rigidity is another common problem in late adulthood. Psychomotor ability is also affected in late adulthood. Some of the psychomotor abilities that are affected as follows:

(i)While all motor abilities decline to some extent, some decline earlier and more rapidly than others.

(ii)Decline in strength is most pronounced in the flexor muscles of the forearms and in the muscles which raise the body. Elderly people tire quickly and require a longer time to recover from fatigue than younger people.

(iii) Decrease in speed with aging is shown in tests of reaction time and skilled movements, such as handwriting. It is especially marked after age sixty.

(iv) In late adulthood, people tend to become awkward and clumsy, which causes them to spill and drop things, to trip and fall, and to do things in a careless, untidy manner. The breakdown in motor skills proceeds in inverse order to that in which the skills were learned, with the earlier learned skills being related longest.

Personality Development in Late Adulthood

Personality development continues even in late adulthood. Late adulthood is the development stage during which people clarify and find use for what they have learned over the years. People can continue to grow and adapt if they are flexible and realistic – if they learn how to conserve their strength, adjust to change and loss, and use these years productivity. People now have a new awareness of time; and they want to use the time they have left to leave a legacy to their children or to the word, pass on the fruits of their experiences, and validate their lives as having been meaningful. Erik Erickson, Robert Peck and George Vaillant have carried out research and have presented their theories and personality development in late adulthood. We would discuss each of them in brief.

Erik Erickson:

According to Erickson, the state of integrity versus despair emerges during the adulthood. Erickson sees older people as confronting a need to accept their lives-how they have lived – in order to accept their approaching death: They struggle to achieve a sense of integrity; of the coherence and wholeness of life, rather than give way to disparate over inability to relieve their lives differently (Erickson & Kivinick, 1986). People who succeed in this final, integrative task- building on the outcomes of the seven previous crises – gain a sense of the order and meaning of their lives within the larger social order, past, present, and future. The “virtue” that develops during this stage is “wisdom” as “informed and detached concern with life itself in the face of death itself (Erikson. 1985. p. 61). Wisdom, Erickson says, include accepting the life one has lived, without major regrets over what could have bee done or what one should have done differently. It involves accepting one’s parents as people who did the bet they could and thus deserve love, even though they were not perfect. It implies accepting one* death as the inevitable end of a life lived as well as one knew how to live it. In sum, it means accepting imperfection in the self, in parents, and life. People who do not achieve acceptance are overwhelmed by despair, realizing that time is too short to seek other roads to integrity. While integrity must outweigh despair if this crisis is to be resolved successfully, Erickson believes that some despair is inevitable. People need to mourn not only for their own misfortune and lost chance but also for the vulnerability and transience of the human condition.

Yet, Erickson also believes that late life is a time to play, to recapture a childlike quality essential for creativity.

Robert Peck: Three adjustments of Late Adulthood. Peck (1955) expanded on Erickson’s discussion on psychological development in late life, emphasizing three major adjustments that people must make. These adjustments allow them to move beyond concerns with work, physical well-being and mere existence to a broad understanding of the self and of life’s purpose. Pecks three adjustments are:

(a)The issue in this adjustment is the degree to which people define themselves by their work. Everyone has to ask” “Am I a worthwhile person only in so far as I can do a full time job; or can I be worthwhile in other, different ways – as a performer of several other roles, and also because of the kind of person I am?” (Peck, 1995, in Nugarten, 1968, p. 90). Retirees especially need to redefine their worth as human beings. People need to explore themselves and find other interest to take the place of the work (whether centered in the marketplace or at home) that had given direction and structure to life. People are more likely to remain vital if they can be proud of personal attributes beyond their work. They need to recognize that their ego is richer and more divers than the sum of their tasks at work.

(b)Transcendence of the body versus pre-occupation with the body -Physical decline creates the need for a second adjustment: overcoming concerns with bodily conditions and finding other sources of satisfaction. People who have emphasized physical well-being as the basis of a happy life may be plunged into despair by diminishing faculties or aches and pains. Those who focus on relationships and on activities that do not demand perfect health adjust better. An orientation away from pre-occupation with the body should be developed by early adulthood, but it is in late life that this orientation is critically tested. Throughout life people need to cultivate mental and social powers that can grow with age, along with attributes like strength and muscular co-ordination that are likely to diminish over the years.

(c)Transcendence of the ego versus pre-occupation with the ego – Probably the hardest, and possible the most crucial adjustment for older people is to go beyond concern with themselves and their present lives and to accept the certainty of death. How can people feel positive about their own death? They can recognize that they will achieve lasting significance through what they have done so far – through the children they have raised, the contributions they have made to the society and the personal relationships they have forged. They transcend the ego by contributing to the well-being of others and this, Peck says, human beings apart from animals.

George Vaillant:

Factors in emotional health – The Grant study, a longitudinal study that began with college sophomores, examined the physical and mental health of 173 of these men at age 65 (Vaillant & Vaillant, 1990). Emotional health at this age was defined as the “clear ability to play and to work and to love” (p. 310 and as having been happy over the previous decade. It is surprising to see the very limited role that various factors play in emotional health. A happy marriage, a successful career, and a childhood free of such major problems as poverty or the death or divorce of parents were all unimportant in predicting good adjustment later in life. More influential was closeness to siblings at college age, suggesting a close family. Factors associated with poor adjustment at age 65 included major emotional problems in childhood and, before age 50, poor physical health, sever depression, alcoholism, and heavy use of tranquilizer. Probably the most significant personality trait was the ability to handle life problems without blame, bitterness or passivity – or, in the researcher’s terms, to use “mature defense mechanisms”. The subjects, who over the years, had not collected injustices, complained, pretended nothing was wrong, or become bitter or prejudiced – and could thus respond appropriately to crises -were the best adjusted at age 65. The best adjusted 65 years olds had also been rated in college as well-organised, steady, stable and dependable; and they continued to show these traits (which were more important than being scholarly, analytic or creative) throughout life. But it some characteristics linked with good adjustment in young adulthood- like spontaneity and making friends easily – no longer mattered. Possible the men who were cecentric and isolated early in life improved their social skills over the years, while the extroverted men did not develop other abilities that may, in the long run, be more valuable (Vaillant & Vaillant, 1990).

Research on Change of Personality

Although basic personality traits (like extroversion, neuroticism, and openness to new experiences) are generally stable throughout life, values and outlook do seem to change in ways like those Erikson proposed. In studies by Carlo Ryff and her associates (1982: Ryff & Bakes, 1976; Rfyff & Heincke, 1983), men and women of various ages reported that they were most concerned with intimacy in young adulthood, with generatively in middle adulthood, and with integrity in late adulthood. They felt that other aspects of their personalities – like impulsiveness, humility and orderliness had not changed. Between the middle and late years, many women’s focus shifted from “doing” to “being”, from instrumental values (like ambition, courage, and capability) to terminal values (such desirable end states of existence as a sense of accomplishment, freedom, and playfulness). Men did not show this kind of shift: middle-aged men were already focused on terminal values, possible because in this cohort, men may have changed their values earlier in life. For some older people, the tendency toward introspection from middle age onward result in their becoming more preoccupied with meeting their own needs. This may be a reaction to lifetimes of caring for and about people; it may also reflect the fact that personal needs are greater in old age.

Family Life of Late Adulthood

Old age is a period of life where drastic changes occur in the family life and it is a period which requires a great deal of adjustment in the sphere of family life. The family life of late adulthood covers the following topics which we will discuss in brief.

  • Married life in late adulthood
  • Psychosexual adjustment
  • Relationship with spouse, offspring, Grandchildren and siblings

Characteristics of marital life in late adulthood, as listed by Brubaker (1983).

(i)Many people in late adulthood continue to remain married.

(ii)Family is still the primary and most important source of emotional support.

(iii) Family life in late adulthood is multigenerational. Most older people’s families include at least three generations, may span four or five. The presence of so many people in family is a source of entertainment for many people.

(iv)Late family life has a long history. Couples continue to remain married for more than 20 to 25 years. This gives their family life cohesion and attachment in spite of conflicts & problems.

(v)Late adult family life is generally satisfying and many say that their marriage had got better over the years.

Married Life in Late Adulthood

There are many stereotyped about the married life of late adulthood period. Many people wrongly believe that older husband and wife are unhappy, isolated, and lonely & rejected by loved ones. No doubt this is true in rare cases. In most cases, married life is satisfying and happy. In one important study the majority of the older couples described this time as the happiest period in their marriage. For older, marriage is more successful. One reason, why older people report more satisfaction with marriage is that people of this age are more satisfied with life in general. Besides this by late adulthood each changed. An age-related decrease in ego energy, one’s mental and emotional resources may also contribute to a more easygoing relationship in late marriage. So too does the tendency to “bloc out” conflict and other stressful situations. According to Adams (1975) the two factors that give the older marriage its unique character are the gradual shift in focus away from the children, and the retirement of the husband (and more recently the wife) from occupational life. Both events provide the couple with increased freedom from outside responsibilities and obligations. Consequently, husbands and wives often find that they have more time for each other during this period than at any other time in their marriage, a factor that seems to facilitate martial happiness. Finally, it should also be noted that marriage is not only quite satisfying during this age period, but it is also psychologically and biologically beneficial. Research indicates that older individuals who are married are less likely to experience loneliness and depression that is the unmarried elderly (Tibbits, 1977). They also show less evidence of mental illness (Hobe. 1973) and they are likely to live longer (Civia, 1967). Satisfaction with marriage among older people is interested it their children are successful and happily married and if they have good relationships with their grandchildren, even if their contracts with them are infrequent. Studies of martial happiness in old age have reveled that older people feel that their marriage have been very satisfactory, that their lives are calmer now that their parental responsibilities arc over, and that they have a new freedom to do as they please. Psychosexual adjustment. Late adulthood is a period which required sexual adjustment. Medical and physical conditions influence sexual behaviour and adjustment among spouses. Men & women generally show a decline in sexual behaviour with advancing age. However recent study by Brody (1978) has pointed out that there is a much longer interest in sex and a greater desire for sexual activity in old age than is popularly believed to exist. In older age, as at other ages, sexual activity has a marked influence on marital adjustment, which in turn affects sexual activity. Diminishing sexual power can have a serious effect on marital adjustment during old age.

Sexual activity continues in old age:

Sexual activity becomes more matured and mutually satisfying rather than a desire to seek personal gratification.

Relationship with

(a) spouse

(b) offspring

(c) Grandchildren and

(d) siblings:

(Elderly individual’s interpersonal relationship with these near and dear ones are greatly influenced by their family environment and personality make up. Relationship with one’s spouse is greatly influenced by the common interest’s health and intellectual development of spouse. Many couples spend time together have cordial relationship with each other and take interest in each other’s activities. It is this period of time where companionship for them is more important Middle and upper-class adults, on the whole spend more of their leisure time with spouses and have more recreational interests in common with them than those of the lower class groups. Relationship in the old age with offspring especially in a nuclear urban family is more formalized. Sussman (1965) have found that older people rely primarily upon their children in times of illness and they receive almost instant help. Older people are of great use of their children. They offer wise variety of help to the offspring’s. Among the types of aid that older parents give their children are money, services such as babysitting or legal advice, and household services such as needlework and woodwork. One group of researchers concluded that “altogether, the proportion of old people who give help to their children tends to exceed the proportion who receives help from their children”. (Riley, Riely & Johnson, 1968). The amount of mutual aid does not seem to depend on how close the generations live, or how often they visit. Some sex-linked patterns do emerge: sons tend to receive money from their elderly parents, whereas daughters receive services (Sussman, 1960: 1965). Research studies have indicated that relationship of elderly people with their children is not free from conflict. Children of elderly people, who are themselves grown up and parents, resent the interference of elderly parents in their life. Researches studies have also found that for the most part, elderly women are absorbed in their relationship with their children than elderly men are. Because women have a closer relationship with their grown children than men have, there is usually more friction between women and their children than between men and their children. Relationship with grandchildren is a source of enjoyment, involvement as well as conflict and tension. In old age, one’s grandchildren are no longer toddlers or schoolchildren. They are adolescents, or older. A number of studies suggest that grand parenting in old age is not always as rewarding as it was earlier. As the grandchild becomes older, and perhaps less attentive, the grandparent experience a kind of “reality shock” that leads to disenchantment (Troll, 1971). One study of older grandparents found that subjects did not feel particularly close to grandchildren, but wee ‘glad to see them come and glad to see them go”. When grandparent and grandchildren live under the same roof, there is likely to be friction between them. When conflicts develop about the grandchildren’s behaviour, they more often involve the mother and the grandmother than the father and the grandfather, Grandfather, one the whole, have fewer and more remote contacts with grandchildren than grandmother do, and they are far less likely to be called on for help in an emergency. As a result, grandmothers generally are more interested and absorbed in the live of their grandchildren than grandfathers are. While the grandfather may be proud of the achievements of his grandchildren and feel that they reflect favorably on family, the reactions of grandmothers are usually more personal and more emotionally toned. Elderly individuals also have siblings who are generally more or less of their age. Relationships with siblings play a very important role in the life of the aging adult particularly for those individuals who have lost a spouse, are divorced, or tow never married (Shanas, 1979). Siblings often provide the support and help that normally would come from a spouse. They act as “confidants”, share family occasions, holidays and recreational activities; aid in decision-making, home- making and home repairs; boost morale; lend money in time of financial need; and provide nursing care and emotional support in times of illness. Research suggests that the influences of siblings on older adults differ depending upon the sex of the sibling and the sex of the individual (Cicirelli, 1977, 1979). Generally female siblings exert a greater influence on both aged men and women. They are more effective in preserving family relationships and providing emotional support. Furthermore, the pretence of sisters tends to reduce the threat of aging for the older man; that is, older men seem happier and less affected by economic and social insecurities when they have living sisters. For aged women, the presence of sisters results in greater concern about social skills, social relationship outside of the family, and community activity. In other words, sisters stimulate each other and tend to facilitate a more stimulating and challenging environment for the older woman.


Ageing is a continuous process which continues throughout life. However, it becomes more pronounced during the adulthood. One of the most dramatic changes that occur due to ageing is the loss of physiological function and changes in physical appearance. Besides, physical changes, many psychological changes also, occur due to ageing. Ageing is a process that is not well understood. As a result, there is a variety of theories that explain the process of ageing in adulthood. Ageing is a series of complex and interrelated changes that occur over time. Timiras (1972) defines ageing as “a decline in physiologic competence that inevitably increases the incidence and intensifies the effects of accidents, disease, and other form of environmental stress, “Most theories of again focus on factors that the either hereditary or environmental in nature as the cause of ageing. Most likely, there is an interaction between genetic and environmental factors that result in the ageing process. Kimmel (1980) lists a variety of hereditary and environmental factors that influence ageing. Heredity functions to influence the life expectancy of all species. Humans have the longest life span of all the mammals while birds, reptiles, insects, and plants each have drastically different life span Kallman.

Patterns of Ageing

Ageing is greatly influenced by one’s personality factors. Successful ageing does not follow any single pattern. How people adapt in old age depends on their personalities and how they have adapted to situations throughout life.(Neugarten et al, 1968) have identified four major patterns of ageing on the basis of their study in which they interviewed 159 men and women aged 50 to 90. The patterns of ageing are as follows:

Integrated :

Integrated people were functioning well, with a complex inner life, a competent ego, intact cognitive abilities, and high level of satisfaction. They ranged from being very active and involved with a wide variety of interests, to deriving satisfaction. They ranged from being very active and involved with a wide variety of interests, to deriving satisfaction from one or two roles to being self-contained and content.

Armour-defended :

People were achievement oriented striving, and tightly controlled. Both those who stayed fairly and those who limited their expenditures of energy, socializing, and experience showed moderate to high levels of satisfaction.

assive dependent:

Passive dependent people either sought comfort from others or were apathetic. Some, who depended on others, were moderately or very active and moderately or very satisfied. Others who ahs been passive all their lives, did little and showed medium or low.

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