THE ADULTHOOD STAGE

1) Young adulthood: The period of young adulthood begins from the age of twenty years onward.
The major concerns of young adults in 20s are to establish themselves in life, job, and family.
The young adult wants to seek social and economic security in preparing for a role of greater
independence and responsibility in society.
2) Middle Age: From the period of his twenties and thirties, the individual arrives at middle age in
the forties and fifties. Middle age is characterized by competence, maturity, responsibility and
stability. These are the important characteristics for middle-aged adults. This is the time when
one wants to enjoy the success of job, satisfaction derived from family and social life. The
individual looks forward to the successes of children. Attention gets more focused on health, the
fate of children, aging parents, use of leisure time and plans for old age. For women, menopause
occurs between the age of forty-five and fifty. Menopause is sometimes accompanied by some
distressing physical and psychological symptoms in women. Men during this period show
greater amount of concern towards their health, strength, power, and sexual potency.
3) Old Age: The period of old age begins at the age of sixty. At this age most individuals retire
from their jobs formally. They begin to develop some concern and occasional anxiety over their
physical and psychological health.
In our society, the elderly are typically perceived as not so active, deteriorating intellectually,
narrow-minded and attaching new significance to religion. Many of the old people lose their
spouses and because of which they may suffer from emotional insecurity.
‘Nobody has ever died of old age’, is a true statement. Since old age is close to the end point of
life, death has been associated with old age. Death is actually caused by disease, pollution,
stress, and other factors acting on the body.
In the biological sense, some organs and systems of the body may start deteriorating. In the
psychological sense, there may be measurable changes in the cognitive and perceptual abilities.
There are also changes in the way a person feels about him/ herself.

PHYSICAL AND COGNITIVE CHANGES DURING ADULTHOOD AND AGING

Normally people see old age as a period of decline in physical and mental health. This section deals
with physical and psychological aspects of aging. With advancing age, there are certain inevitable and
universal changes such as chemical changes in cells, or gradual loss of adaptive reserve capacity. There
are also certain cognitive changes taking place from middle adulthood onwards. These changes are
slow and gradual. They become more prominent among the elderly people.
a) Physical Changes- It has been found that the organ system of most persons show a 0.8 to 1
percent decline per year in functional ability after the age of 30. Some of this decline is normal,
some is disease related and some are caused by factors such as stress, occupational status,
nutritional status and various environmental factors. Major physical changes with ageing are
described as
i. external changes
ii. internal changes
iii. Changes in sensory capacities.

i. External Changes- It refers to the outward symptoms of growing old. The more observable
changes are those associated with the skin, hair, teeth, and general posture. There are changes in
the skin. The most pronounced change is wrinkling. Wrinkling process begins during middle
years. Skin also becomes thick, hard and less elastic. It becomes brittle and dry.
 With advancing age, the hair of the person continues to turn white and loses its luster. It
continues to thin. By the age of fifty-five, about 65 percent of men become bald.
It is estimated that at age 65, fifty percent people have lost all their teeth. For many, dentures
become a way of life. Over the time, the production of saliva is diminished. This increases the
risk of tooth decay.
Physical strength begins to decline from age 30 to age 80 and above. Most weakening occurs in
the back and leg muscles, less in the arm muscles. There is a progressive decline in energy
production. Bones become increasingly brittle and tend to break easily. Calcium deposits and
disease of the joints increase with age.
Muscle tissue decreases in size and strength. Muscle tone becomes increasingly difficult to
maintain with age because of an increase in fatty substance within the muscle fibers. This is
often caused by the relative inactive role thrust on the elderly in our society. Exercise can help
maintain power and sometimes even restore strength to the unused muscles. Changes in the
general posture become more evident in old age. The loss of teeth, balding and greying of the
hair, wrinkling of the skin and lack of physical strength all has a potentially negative effect on
an individual’s self-concept and confidence.
ii. Internal Changes -It refers to the symptoms of growing old that are not visible or obvious. We
shall examine some of the changes taking place with increasing age in the respiratory system,
gastrointestinal system, cardiovascular system, and central nervous system.
The Respiratory System: With increasing age, there is reduction in breathing efficiency. The
lungs of an old person do not expand to take in as much air as the lungs of a young person.
Decreased oxygen supply makes the old person less active, less aware and less strong. This decline
seems to be part of normal aging process.
The Gastrointestinal System : With increasing age there is decreased capacity for biting and
chewing, decrease in the production of digestive enzymes, decreased gastric and intestinal mobility
and lack of appetite.
The Cardiovascular System: Cardiovascular system which includes the heart and the blood
vessels show the effects of normal aging rather slowly. With the aging process there is a decrease in
the elasticity of blood vessels and blood cell production also. Increase-in time required for heart to
return to rest and arterial resistance to the passage of blood is also found. Many old individuals are
found to be suffering from high blood pressure. However, healthy old individuals are found to have
blood pressure similar to those of young healthy individuals.
The Central Nervous System (CNS): The CNS shows certain universal changes as a function of
age. There is decreasing rate of arterial and venous flow. Beginning at about age 60, there is a
reduction of cerebral blood flow. There is also a decline in oxygen and glucose consumption.
Number of cells and cell endings are found to be decreasing. The most definite change is the
slowing down of responses.
iii. Changes in Sensory Capacities -with advancing age, there is gradual slow down in the sensory
abilities. We communicate with the outer world through our senses. Losses in any senses can
have profound psychological consequences.
Vision: Increasing age brings in several problems in vision. The lens continues to lose elasticity.
The pupils become smaller, irregular in shape. The eyelids have a tendency to sag. Color vision
becomes less efficient. Cataract and glaucoma are commonly found among the elderly. People
with cataracts have blurred vision. This also interferes with normal vision.
Hearing: Hearing seems to be at best around the age 20. From then onwards there is a gradual
decline. Most hearing loss is not noticed. However, in the case of hearing problem, it can be
improved by a hearing aid.
 Other senses: The senses of taste and smell decline with old age. This decline affects appetite
and nutritional requirements of the elderly. You must have noticed that many old persons
demand food that is overly sweet or spicy. This is because the four basic tastes, sweet, bitter,
sour, and salty, all generally diminish in sensitivity. Sensitivity to touch appears to increase from
birth to about 45 and then decreases sharply.

Nutritional Concerns
Ageing involves changes in physiology and function of the body. These changes have a profound
influence on the nutritional status of the ageing adult and affect the body’s metabolism, nutrient intake,
absorption, storage, utilization and excretion of nutrients, nutrient requirements and the ability to
choose, prepare and eat a variety of foods. It is important to understand how changes in body
composition and physiology relate specifically to risk for chronic disease morbidity and mortality.
1) Sarcopenia-It defined as an age-related decline in muscle mass may represent an advanced
stage of progressive age-related body composition changes. There is dramatic change is body
composition with age and a tendency to deposit excess fat overtime and an inevitable loss of
lean body mass and bone mineral density.
Abnormal body composition or central (abdominal) distribution of fat can result in adverse
effect on health. This can lead to abnormalities in carbohydrate metabolism, lipid high blood
pressure and a major risk factor for development of non insulin dependent diabetes. Loss of
muscle mass increases with advancing age and accelerates after the age of 80 years. There is
loss of muscle mass by 1-2% a year after the age of 50 years and at 5% each decade from the
age of 40 years. Reduction in muscle mass leads to a fall in basal metabolic rate (BMR), which
has been associated with age in many earlier studies.
2) Osteoporosis –It is a metabolic condition accompanied with advancing age in which the amount
of calcium in bone is reduced making them porous. Ageing is associated with a loss of bone and
total body calcium. It is very common among women in post-menopausal phase of life. Possible
cause of osteoporosis may be a diet deficient in calcium, vitamin D, fluoride and a diet
containing excessive amounts of phosphorus also accelerates bone loss. Also impaired intestinal
absorption and reduced renal re-absorption can aggravate bone demineralization.
Older people are at increasing risk of developing osteoporosis, hip and wrist fractures, spinal
compression fractures and locomotors disabilities as they [Link] factors for osteoporosis
include frailty, under nutrition, unsafe home environment, inability to exercise, dementia etc.
Adequate food source of calcium together with vitamin D may account for better bone health.
3) Obesity -It is defined as excessive accumulation of body fat resulting in adverse effect on health
associated with other chronic diseases. It is emerging as an important health problem among
elderly women as it predisposes them to reduce functional ability and increased morbidity. The
fundamental cause of obesity is excessive consumption of high calorie foods with less physical
activity level. It is associated with other diseases such as diabetes, cardiovascular diseases,
hypertension, cancers and polycystic ovarian diseases. Dietary prevention for obesity include
limited intake of fats, elimination of trans fatty acids, increasing physical activity level ,
reducing intakes drinks high in sugars, limited salt consumption, increase consumption of fruits
and vegetables, can prevent unhealthy weight gain.
4) Oral health and dentition- With increasing age several functional changes and disability occur.
By age of 60, the risk of disability arise from age related losses in hearing, seeing and moving,
and non-communicable diseases, including heart disease, stroke, chronic respiratory disorders,
cancer and dementia.
Oral health is one of the crucial and a key component of healthy ageing. Poor oral health can
negatively impact on general and well being in elderly people. In some older adults, the
 experience of pain while eating and chewing without their natural teeth, discolored or damaged
teeth have a major impact on functional ability and older people’s daily lives. Such experiences
are more likely to eat a restricted variety of foods which are difficult to chew such as some
vegetables, fruit and nuts, and some meats. These may hamper their enjoyment of eating thereby
limiting food and nutrient intakes. Dry mouth also refers to as xerostomia, is also common with
advancing age. It can be significant problem for oral health and functioning by interfering with
the intake of food, affecting the taste and problems ranging from chewing to swallowing. Dental
caries or tooth decay and gum disease are very common in older adults. Diets rich in sugar and
consumption of high energy drinks are a cause of dental caries. It is very difficult for older
people with functional limitations to maintain good oral health.
5) Alzheimer’s disease-It is an irreversible and progressive deterioration of the brain characterized
by memory loss, disorientation, depression and deterioration of bodily function. The onset of the
disorder is insidious and more common with increasing age which usually occurs after age of
65yrs. However, Alzheimer patient may manifest progressive cognitive and emotional changes
as early as the 50-60yrs. Associated psychological changes include memory failure, gradual
deterioration of cognitive abilities, personality and behavior deterioration. Decline in mental
alertness, adaptability, sociability, untidy, agitated and self-centered attitude are some other
associated symptoms. The exact cause of Alzheimer’s disease is unknown but some suggested
causes are alterations in the protein production in the brain, strokes, high free radicals,
biochemical deficiencies of certain enzymes and chromosomal defect. Adequate intake of folate,
vitamin B12 and B6, diet rich in omega 3 reduces the risk of Alzheimer’s disease.
6) Dementia-It is defined as a decline in cognitive, intellectual and memory functions due to
disease processes affecting central nervous system. Prevalence of dementia increases with
advancing age and it is well known that age is a risk factor for dementia. People suffering from
dementia may manifest impaired memory, impairment in abstract thinking, altered judgments
and personality changes. It mainly affects the older people and only 25 cases start before the age
of 65 yrs.