Term Paper: Older Adulthood
Developmental theorist Eric Erickson found that psychological growth and development can occur throughout the life span. He identified eight life stages, each with a specific psychosocial problem that, if successfully resolved, brings about growth and the potential to master the next stage. The eighth and final life stage he called “maturity.” At this juncture, a person comes to realize that his or her life cannot be relived. Successful negotiation brings about ego integrity—a sense of peace with life as it was lived. If integrity does not develop, the person experiences despair, and regret about one’s life dominates. There is fear that death will come before a meaningful life can be experienced. Alternatively, a sense of integrity fosters wisdom. Erickson viewed the wise elder as contributing to society and future generations through interactions with younger people.
Compared to studies of intelligence, little research has been conducted on wisdom. Difficulty in defining and measuring this construct is likely the reason. In many situations, wisdom may be as valuable as intelligence, particularly in a rapidly changing technological world that requires personal flexibility.
Knowledge is an aspect of wisdom and includes the ability to know the limits of one’s knowledge. Wisdom also involves knowing what problems need solving and what problems can be let go. It includes the desire to evaluate things in depth. Those who possess wisdom have a tolerance for ambiguity and for things that inevitably get in the way. Further, those who are wise are motivated to understand and appreciate the impact of the context that surrounds a situation.
Importance of relationships
Social contact is an essential human element that has direct effects on health and emotional well-being. Relationships also act as potential buffers against stress. Numerous studies have shown that stress negatively affects one’s immune system. This is of particular importance for the elderly because immune functioning tends to diminish with age. New evidence is emerging that strong social relationships also promote recovery from certain illnesses. A recent study of 180 elderly men showed that those who experienced emotional support and companionship were at lower risk for developing heart disease. Another investigation found subjects who had strong relationships to be at lower risk of dying after a myocardial infarction than those who lacked supportive relations. Death rates are higher among people who are socially isolated. The sheer number of relationships is not the important factor, but the quality. For example, the presence of a family member does not automatically imply a meaningful relationship. Extensive research on gender differences suggests that the nature of relationships differs for men and women. Women tend to have more intimate connections. They benefit from having more positive feelings toward relationships. However, women also tend to suffer more from relationships because investment in others’ concerns can lead to increased conflict and stress. For this reason, relationships for men sometimes can provide greater protection from stress.
Both fulfilling informal and formal human connections can be healthful. Formal supports may include a member of the clergy, housekeeper, visiting nurse or psychotherapist. Informal relations are family members and casual contacts, perhaps the grocery store clerk. For some elderly, close neighbors are a crucial source of informal support. Studies indicate that pets are a source of relational support. Elderly pet owners have been shown to be less depressed, better able to tolerate social isolation and be more active than those without pets.
Relationship loss is common in late adulthood. Parents are deceased, and siblings and contemporaries begin to die. The opportunity for expression of sadness is critical for emotional healing; however, depression is not a normal state for the elderly. Consider Jane, who at 92 lives in a retirement home. She has no living siblings, has one remaining son of three children and has outlived two husbands. Notwithstanding these losses, she has a handful of meaningful friendships, is involved in her church and is well-liked by the staff members.
Researchers who followed subjects from adolescence to old age in a large-scale qualitative study of adult development discovered valuable information about relationships and aging. Positive relationships at any age of the person’s life were found to correlate to satisfaction in old age. A satisfying marriage at age 50 predicted positive aging at 80. Contentment in later life was the outcome for subjects who had the ability to express gratitude and forgiveness in relationships. Overall, researchers determined that loving relationships promote personal growth and emotional healing.
Successful aging also involves learning to play and be creative after retirement. This ability to adapt to situational and physical changes helps explain why some people age more successfully than others.
Cohort effects need to be taken into account in clinical situations as well as research with the elderly. (Cohort refers to membership in a group as defined by a person’s birth year.) Much of the difference between young and older groups is due to cohort effects. Cohort groups are socialized into certain beliefs, attitudes and abilities based on the time in history in which they live. These factors remain stable as the cohort ages. Twenty years from now, a cohort of elderly Americans will look different than the current group because of different historical experiences. For instance, older people 20 years from now will have more formal education than today’s cohort of elderly. The way health care providers interact with and conduct patient teaching will need to be modified for each new cohort.
Sexuality in later life
Elderly couples may have inaccurate assumptions about aging and sex. Health care providers can sensitively present factual information to patients about the effects of aging, illness and medications on sexual functioning.
The likelihood of sexual activity during later life is related to how sexually active a person was during his or her younger years. Given an available partner, a person who was sexually active in younger years is likely to remain active into late adulthood.
Men who have been sexually active generally can engage in some sort of sexual activity well into their 70s or 80s. About 90 percent of erectile problems are physical rather than psychological. To have an erection, the man must be in a responsive state of mind and have normal hormone functioning, including adequate testosterone levels and penile blood supply. Possible impediments include hypertension, elevated cholesterol, diabetes, coronary artery disease, smoking, alcohol abuse and medications (especially those used to treat hypertension and depression). Surgeries such as a radical prostatectomy also may cause erectile problems. Aging itself is not to blame.
Reports indicate that about 52 percent of men aged 40 to 70 have some degree of erectile dysfunction. About one out of four men aged 65 to 80 have serious problems achieving and sustaining erections. In the group of men older than 80, one out of two have substantial erectile problems. Sildenafil citrate (Viagra) works for more than half of men who use it. Perhaps due to humiliation, shame or the belief that there is no help, few men seek medical attention for sexual problems.
As a man enters late adulthood, it is normal for erections to occur less frequently. More stimulation is needed for arousal. The ability to have repeated ejaculations is lessened, but once achieved, an erection lasts longer. Ejaculation also can be delayed. Volume of semen remains the same, but sperm counts are lowered. This information will help the man and his partner understand normal changes.
Physiologically, women are able to be sexually active as long as they live. A woman who enjoyed sex in younger years is likely to want to continue. The problem often, however, is the lack of a partner. In 1998, 46 percent of women older than 65 were widowed while only 15 percent of men were. Women who had orgasms in their younger years will likely be able to do so well into their 80s or later. Sex, however, will be different later in life than it was during earlier periods. Orgasms tend to be shorter, and muscle contractions are fewer in number. With age, women may take longer to become sexually aroused. Decreased ovarian estrogen production following menopause is likely to create vaginal dryness, leading to painful intercourse. Older women may need information about use of lubricants to ameliorate this problem. Some aging women feel self-conscious about their appearance. As a woman ages, weight gain is common, as are changes in body shape due to redistribution of adipose tissue around the abdominal area. Counseling can provide an opportunity for discussion about feelings related to normal body changes and help a woman feel more comfortable with and knowledgeable about her physical self. Non-intercourse avenues of sexual expression can be encouraged between elder adults.
Sexual functioning in both sexes is likely to be enhanced by physical fitness. Partners who are in good physical condition are more likely to enjoy sex. They possess the energy requirements for intercourse. Pain, from conditions such