Behavioral Science

Jeff Jarosinski, PhD

[email protected]
Goal 30: Describe the major theories concerning
normal human development.
30d. Understand the transitional states associated
with the stages of aging in adulthood.
30e. Discriminate how the changing world population
demographics are altering how we define and
conceptualize aging.
30f. Differentiate how aging transforms the anatomy,
physiology and function of the human body and
brain.
30g. Given the associated risk factors common with
being elderly, discriminate which of the elderly are
the most vulnerable to abuse and suicide.
Which of the following changes can be
viewed as a normal part of aging?

A. Significantly decreased cognitive capacity

B. Increased depression
C. Increased fears of illness
D. Increased agitation
E. Decreased performance speed
Mollie, a 75-year-old female reports that she feels she is
beginning to forget some things like where she placed
her glasses and whether she has turned off the stove
after cooking. She is sure to double check when this
happens. She denies all other memory difficulties and
her family does not have any concerns regarding her
ability to live alone. Based on the symptoms above, what
is this patient’s most likely diagnosis?

A. She has become depressed

B. This is normal aging
C. She has the beginning stages of Alzheimer’s disease
D. She has had a small stroke
Adulthood
Although adulthood begins
sometime after a person’s
mid-twenties, defining
adulthood into stages is
more difficult than defining
the stages of childhood or
adolescence.

Rick Doyle/ Corbis

5
Stages of Adulthood
 Ages 20 - 35/40: Early Adulthood

 Ages 35/40 - 65: Middle Adulthood

 Ages 65 and greater: Late Adulthood

Erikson’s stages
 During adulthood we are talking about
stages 6, 7, and 8:

 Intimacy vs. Isolation

 Generativity vs. Stagnation
 Ego Integrity vs. Despair
Stage Basic Conflict Important Events Outcome

Young Intimacy vs. Relationships Young adults need to form

Adulthood Isolation intimate, loving relationships
(20 to 35/40 with other people. Success
years) leads to strong relationships,
while failure results in
loneliness and isolation.

Work and Generativity vs. Adults need to create or Success leads to feelings of
family Stagnation nurture things that will outlast usefulness and
(35/40-65) them, often by having children accomplishment, while failure
or creating a positive change results in shallow involvement
that benefits other people. in the world.

Maturity(65 Ego Integrity vs. Reflection on Life Older adults need to look back
to death) Despair on life and feel a sense of
fulfillment. Success at this
stage leads to feelings of
wisdom, while failure results in
regret, bitterness, and despair.
Intimacy vs. Isolation
 Stage 6 – Erikson’s Psychosocial Development

 21-35/40 years old

 Basic Strengths: Affiliation and love

 In the initial stage of being an adult we seek one or more

companions and love. As we try to find mutually satisfying
relationships, primarily through marriage and/or friends, we
generally also begin to start a family, though this age has been
pushed back for many couples who today don't start their families
until their late thirties.

 If negotiating this stage is successful, we can experience intimacy

on a deep level. If we're not successful, emotional isolation and
distance from others may occur.
Emerging Adulthood
Emerging adulthood spans ages 18-25. During this
time, young adults may live with their parents and
attend college or work. On average, emerging adults
marry in their mid-twenties.

Ariel Skelley/ Corbis

10
U.S. Families – The Current Trends

  single parent families

  birth rate for mothers aged 35-44
  Both parents working full time
 High divorce rate
Early Adulthood
 Marriage and Divorce:
 Marriage rates have dropped to record lows.
 Highest divorce rates are during early adulthood.
 One half of first marriages of adults who are in their 30s
will end in divorce.
 Most adults will remarry and half of second marriages will
also end in divorce.
 Marital satisfaction decreases during the child rearing
years due to stress.
 Divorce can also cause mental health problems including:
○ psychological loss.
○ financial and legal issues.
○ reconfigured social network.
Infidelity
 Men 33% of those married have been unfaithful.
 Women 25% have been unfaithful (Greeley, A. Marital infidelity, Society, 1994).
 Risk Factors for either partner include:
 New career stress/ job change.
 Traveling extensively alone.
 Depression linked with a failure.
 Work monotony or fatigue.
 Pregnancy or birth of a new child.
 Children demanding attention.
 Death of a parent, child, sibling or friend.
 Accidents/illness.
 Children leaving home.
 Moving, major lifestyle changes, buying a new home.
Generativity vs. Stagnation
 Stage 7 – Erikson’s Psychosocial Development
 35/40-65 years old
 Basic strengths: productivity and creativity
 Work is crucial. Middle-age is when we tend to be occupied with
creative and meaningful work and with family issues.
 Strength comes through care of others and production of something
that contributes to the betterment of society, which Erikson calls
generativity. When we're in this stage we often fear inactivity and
meaninglessness.
 As children leave home or relationships or goals change, we may
be faced with major life changes - the mid-life crisis or opportunity
- and struggle with finding new meanings and purposes.
 If we don't get through this stage successfully, we can become self-
absorbed and stagnate.
Middle Adulthood
 Employment
 Job satisfaction becomes important
 Unemployment has some very serious
consequences
○ Alcoholism
○ Violence
○ Suicide
○ Mental illness
 Health Status in Middle
Adulthood
 78% of adults in this stage of adulthood report their
overall health as “good” or “excellent”.
 Chronic illnesses begin to emerge at this time; this
leads to the need for behavioral/schema changes
and struggling with the challenges of adapting to
aging. This can include:
 Modifying lifestyle.
 Tolerating body changes and losses.
 Maintaining a positive outlook and self image.
 Maintaining positive relationships, including with their
physicians.
• Adaptation to Life (1977): Study of
Healthy Adults
○ Close sibling relationships predicated stable middle
age.
○ A good marriage at age 50 predicted positive aging at
80.
○ Low cholesterol levels at age 50 did not predict positive
aging at 80.
○ Alcohol abuse consistently predicted unsuccessful
aging.
○ Learning to “play and create” after retirement added
more to life’s enjoyment than retirement income.
○ Objective good physical health was less important to
successful aging than subjective good health.
Ego Integrity vs. Despair
 Stage 8 – Erikson’s Psychosocial Development
 65 and older
 Basic strength: Wisdom
 Erikson felt that much of life is preparing for the middle
adulthood stage and the last stage is recovering from it. Perhaps
that is because as older adults we can often look back on our
lives with happiness and are content, feeling fulfilled with a
deep sense that life has meaning and we've made a contribution
to life, a feeling Erikson calls integrity.
 On the other hand, some adults may reach this stage and feel
despair at their experiences and perceived failures. They may
fear death as they struggle to find a purpose to their lives,
wondering “was the trip worth it?"
Retirement
 Generally reserved for those aged 65
and over.
 Some professions however encourage
early retirement.
 Generally after traditional retirement age
individuals have 16-20 more years of life
to enjoy.
 If persons are not yet ready to retire, this
can lead to psychological stresses and
crises.
Aging statistics
 In 1900 average life expectancy = 48.
 The elderly are a NEW GROUP.
 They are the largest increasing age group.
 They will increase their numbers by 125%
in 30 years.
 This population will require three times the
nursing care facilities.
Life Expectancy in the U.S.
 CDC has reported that babies born in 2011
will live on average 78.6 years (males: 76.1
years, females: 80.9 years)
 This life expectancy ranks 37th in the world.
 Countries surpassing the US include
 Japan
 Most of Europe
 Jordan
 Guam
 Cayman Islands
Stressors in late adulthood
 Psychological
 Awareness of mortality
 Changes in cognitive functioning
 Bereavement
 Social
 Changes in residence
 Children leaving home
 Loss of support group
 Decreased income
 Retirement
 Retirement from driving (Aronson, L. 2019, NEJM)
Biological Changes Associated
with Aging
 Reduced acuity of taste,  Psychomotor speed
smell, touch declines
 Yellowing of optic lens  Shifting attention is
 Decreased hardness of performed with difficulty
erection  Encoding ability diminishes
 Decreased vaginal  Simple recall declines
lubrication  Recognition of right
 Takes longer to learn new answer on multiple choice
material remains intact
 IQ remains stable until  Decreased norepinephrine
about age 80  Decreased cerebral blood
 Verbal ability is maintained flow
Mental and Social Health
Issues
 Elderly tend to underutilize mental
health services.
 Depression and alcoholism are common
problems in the elderly.
 Suicide is higher among elderly males
than any other group.
 Elder abuse is a concern.
How will changing demographics in impact
your work as a physician?

 Increase in single parent families.

 Increase in number of women who are
caretakers for both young children and aging
parents.
 The elderly as a new and fast growing age
group.
Interviewing the Elderly
 LISTEN
 Allow time and space for them to share.
 Speak slowly and clearly
 Sit face to face and make eye contact.
 One task at a time
 Simplify information and summarize it;
allow for questions.
 Write down instructions and use visual aids
 Mental status, ADLs, and social
relationships are important areas to cover.
Which of the following changes can be
viewed as a normal part of aging?

A. Significantly decreased cognitive capacity

B. Increased depression
C. Increased fears of illness
D. Increased agitation
E. Decreased performance speed
Which of the following changes can be
viewed as a normal part of aging?

A. Significantly decreased cognitive capacity

B. Increased depression
C. Increased fears of illness
D. Increased agitation
E. Decreased performance speed
 Mollie, a 75 year old female, reports that she feels she
is beginning to forget some things like where she
placed her glasses and whether she has turned off
the stove after cooking. She is sure to double check
when this happens. She denies all other memory
difficulties and her family does not have any concerns
regarding her ability to live alone. Based on the
symptoms above, what is this patient’s most likely
diagnosis?

A. She has become depressed

B. This is normal aging
C. She has the beginning stages of Alzheimer’s
disease
D. She has had a small stroke
 Mollie, a 75-year-old female reports that she feels she
is beginning to forget some things like where she
placed her glasses and whether she has turned off
the stove after cooking. She is sure to double check
when this happens. She denies all other memory
difficulties and her family does not have any concerns
regarding her ability to live alone. Based on the
symptoms above, what is this patient’s most likely
diagnosis?

A. She has become depressed

B. This is normal aging
C. She has the beginning stages of Alzheimer’s
disease
D. She has had a small stroke
Goal 30: Describe the major theories concerning
normal human development.
30d. Understand the transitional states associated
with the stages of aging in adulthood.
30e. Discriminate how the changing world population
demographics are altering how we define and
conceptualize aging.
30f. Differentiate how aging transforms the anatomy,
physiology and function of the human body and
brain.
30g. Given the associated risk factors common with
being elderly, discriminate which of the elderly are
the most vulnerable to abuse and suicide.