Midlife Change Research Articles

Fat mass and obesity gene and cognitive decline

To determine whether 4 genetic variants in the fat mass and obesity associated gene (FTO) identified in genome-wide association studies of diabetes and obesity are associated with cognitive change in midlife in the Atherosclerosis Risk in Communities (ARIC) Study. ARIC is a prospective cohort study of the development of atherosclerosis in 15,792 individuals aged 45 to 64 years at baseline from 1986 to 1989. FTO is highly expressed in human fetal and adult brain, and a single nucleotide polymorphism in FTO has previously been associated with reduced brain volume in cognitively normal subjects. Since a relationship between brain atrophy and diminished cognitive function has been demonstrated in ARIC participants, general linear models were used to evaluate the association between 6-year change in scores on 3 neuropsychological tests and FTO genotype. In a sample of 8,364 white and 2,083 African American men and women with no clinical history of stroke, significantly greater mean change in performance on the Delayed Word Recall Test was associated with 2 of 4 FTO single nucleotide polymorphisms examined (rs9939609, rs805136, rs17817449, and rs1421085) in whites but not in African Americans (p ≤ 0.002). The association of the FTO polymorphisms with cognitive change was independent of potential confounding clinical and demographic variables including age, gender, education, diabetes, hypertension, and body mass index. Further studies will be needed to clarify the biological mechanisms and genetic pathways through which variants in FTO can increase susceptibility to decline in verbal memory detectable in middle-aged, community-dwelling adults.

49 EVIDENCE WITHIN FAMILIES THAT BODY MASS INDEX BUT NOT SYSTOLIC BLOOD PRESSURE IS INFLUENCED BY MIDLIFE CHANGES IN SOCIOECONOMIC POSITION

Background: Using adult families to study the association of socioeconomic position (SEP) with cardiovascular risk (CVR) may help elucidate the relative contributions of early and midlife environmental influences. Methods: We used variance components statistical models in the Victorian Family Heart Study (n = 1147) to assess association of 4 socioeconomic indices with systolic blood pressure (SBP) and body mass index (BMI), in families where at least one adult child had left the parental home. We also investigated relative effects of personal SEP, parental SEP and parental CVR on offspring who had left home. Results: After adjustment for age, sex and within-family correlation, we found that 2 of the 4 socioeconomic indices were associated with SBP (p < 0.01 and p < 0.04, maximum β = 0.86 mmHg), and all 4 indices were associated with BMI (10−4 < p < 0.04, maximum β = -0.54 kg/m2). For the children who had left home (n = 319), neither personal SEP nor parental SEP was associated with SBP (all p > 0.27) but parental SBP was strongly associated with SBP (p < 0.01). In contrast, personal SEP (p < 0.01) was more strongly associated with BMI than either parental SEP (p = 0.64) or parental BMI (p = 0.37). Conclusions: These analyses indicate a modest association between SEP and CVR even within families. The discrepant patterns of association of SEP in offspring who have left home suggest that early life experiences (rather than midlife SEP) might be more important for SBP, but that BMI is susceptible to changes in SEP midlife.

SWITCHING TO ENTREPRENEURSHIP IN MID CAREER: A SINGAPOREAN PERSPECTIVE

The phenomena of an aging population, changing social and economic circumstances, as well as the existential necessity of mid-life changes form the background to this investigation. Though statistics indicate that there are only a few who have considered entrepreneurship as a desirable and feasible career option in mid life, the option is becoming more attractive as the possibility of lifetime employment with a single employer becomes increasingly remote. The focus of this article is to understand what has motivated first time entrepreneurs in mid-career to consider this choice and how they have made sense of their mid-life situations to successfully discover and exploit entrepreneurial opportunities. This study has demonstrated that it requires the optimal interaction of four key elements to increase the likelihood of a positive outcome of entrepreneurial pursuits — knowledge, networks, rewards and risks.

The PREVENT study: a prospective cohort study to identify mid-life biomarkers of late-onset Alzheimer's disease

IntroductionEpidemiological studies indicate that significant decreases in the incidence of Alzheimer's disease (AD) may be obtained by targeting multiple middle-age risk factors. However, as dementia is unlikely to be diagnosed...

Predictors of Psychological Well-Being of Adolescents’ Parents

Informed by theories about processes in families with adolescent children, this study examined the contribution of self-perceived decline in physical and cognitive functioning related to midlife, marital satisfaction, and parent–child conflict to psychological well-being of parents of young adolescents. Parental well-being was conceptualized within Ryff’s multidimensional model, which encompasses six dimensions: Autonomy, Self-Acceptance, Environmental Mastery, Positive Relationships with Others, Personal Growth, and Purpose in Life. In examining relationships between parental well-being and supposed predictors, sociodemographic variables (parental age and education), perceived general life stress, and perceived available social support were controlled for. Participants were Croatian mothers (N = 356) and fathers (N = 328) whose oldest child was transitioning to adolescence. Overall, the patterns of associations between the studied predictors and well-being dimensions were similar for mothers and fathers. The main finding of the study was that individual differences in the psychological well-being of adolescents’ parents may be more attributable to self-perceived midlife changes (particularly for mothers) and marital satisfaction (particularly for fathers) than to perceived level of parent–adolescent conflict.

Critical Transition in Tissue Homeostasis Accompanies Murine Lung Senescence

BackgroundRespiratory dysfunction is a major contributor to morbidity and mortality in aged populations. The susceptibility to pulmonary insults is attributed to “low pulmonary reserve”, ostensibly reflecting a combination of age-related musculoskeletal, immunologic and intrinsic pulmonary dysfunction.Methods/Principal FindingsUsing a murine model of the aging lung, senescent DBA/2 mice, we correlated a longitudinal survey of airspace size and injury measures with a transcriptome from the aging lung at 2, 4, 8, 12, 16 and 20 months of age. Morphometric analysis demonstrated a nonlinear pattern of airspace caliber enlargement with a critical transition occurring between 8 and 12 months of age marked by an initial increase in oxidative stress, cell death and elastase activation which is soon followed by inflammatory cell infiltration, immune complex deposition and the onset of airspace enlargement. The temporally correlative transcriptome showed exuberant induction of immunoglobulin genes coincident with airspace enlargement. Immunohistochemistry, ELISA analysis and flow cytometry demonstrated increased immunoglobulin deposition in the lung associated with a contemporaneous increase in activated B-cells expressing high levels of TLR4 (toll receptor 4) and CD86 and macrophages during midlife. These midlife changes culminate in progressive airspace enlargement during late life stages.Conclusion/SignificanceOur findings establish that a tissue-specific aging program is evident during a presenescent interval which involves early oxidative stress, cell death and elastase activation, followed by B lymphocyte and macrophage expansion/activation. This sequence heralds the progression to overt airspace enlargement in the aged lung. These signature events, during middle age, indicate that early stages of the aging immune system may have important correlates in the maintenance of tissue morphology. We further show that time-course analyses of aging models, when informed by structural surveys, can reveal nonintuitive signatures of organ-specific aging pathology.

Preservation of femoral bone thickness in middle age predicts survival in genetically heterogeneous mice

To see whether age-related changes in bone could predict subsequent lifespan, we measured multiple aspects of femur size and shape at 4, 15, and 24 months of age in genetically heterogeneous mice. Mice whose cortical bone became thicker from 4 to 15 months, associated with preservation of the endosteal perimeter, survived longer than mice whose endosteal cavity expanded, at the expense of cortical bone, over this age range. Femur size at age 4 months was also associated with a difference in life expectancy: mice with larger bones (measured by length, cortical thickness, or periosteal perimeter) had shorter lifespans. Femur length, midlife change in cortical bone thickness, and midlife values of CD8 T memory cells each added significant power for longevity prediction. Mice in the upper half of the population for each of these three endpoints lived, on average, 103 days (12%) longer than mice with the opposite characteristics. Thus, measures of young adult bone dimensions, changes as a result of bone remodeling in middle age, and immunological maturation provide partially independent indices of aging processes that together help to determine lifespan in genetically heterogeneous mice.

Midlife memory improvement predicts preservation of hippocampal volume in old age

This study examines whether midlife change in episodic memory predicts hippocampal volume in old age. From the Seattle Longitudinal Study we retrospectively identified 84 healthy, cognitively normal individuals, age 52 to 87, whose episodic memory had reliably declined (n = 33), improved (n = 28) or remained stable (n = 23) over a 14-year period in midlife (age 43–63). Midlife memory improvement was associated with 13% larger hippocampal volume (p < 0.01) in old age (age 66–87), compared with old age individuals whose midlife episodic memory had either declined or remained stable during midlife. Midlife memory change did not predict total hippocampal volume for those currently in late middle age (age 52–65). The pattern of findings was not modified by gender, apolipoprotein ε4 status, education or current memory performance. Change in midlife memory scores over 14 years, but not any single assessment, predicted hippocampal volumes in old age, emphasizing the importance of longitudinal data in examining brain-cognition relationships. These findings suggest that improvement in memory in midlife is associated with sparing of hippocampal volume in later life.

Paring down life to the essentials: An epicurean psychodynamics of midlife changes.

Paring down life to the essentials: An epicurean psychodynamics of midlife changes.

Reclaiming Embodiment within Critical Psychology: A Material‐Discursive Analysis of the Menopausal Body

AbstractSocial and Critical Psychology have been accused of ‘disembodying’ the discipline through the negation of embodied experience. In contrast, Bio‐Medicine and Biological Psychology focus on the body, within a realist framework. A material‐discursive approach, and a critical‐realist epistemology, is proposed as a way forward to examine embodiment in a socio‐cultural context, wherein the materiality of the body is recognised, but always mediated by culture, language, and subjectivity. As a case example, women's experience of embodied change at menopause is examined. The bio‐medical positioning of the menopausal body as the site of disease, distress, and debilitation, necessitating medical management, is contrasted with women's reports of minimal distress, and effective negotiation of midlife changes. Cultural context, relational factors and the positioning of embodied changes as symptoms, or as natural, are key factors determining women's coping. This material‐discursive approach thus allows us to ‘re‐embody’ psychology and move beyond the mind–body divide.

Sosein

In light of the increase in life expectancy in the 20th century, a growing number of people are making significant midlife changes. This article tries to steer a way between two cultural myths about this life period. The first is that the only sane solution of the midlife crisis is acceptance of growing limitations. The second is the idea that, given drive and a vision, we are capable of boundless change. The alternative middle way proposed is called “active self-acceptance.” It is based on Karl Jaspers's notion that we are all condemned to failure vis-à-vis boundary situations and that there is a Sosein (being thus and no other) that is recalcitrant to change. Jaspers's biography and an extended case example show that active self-acceptance is not passive resignation but initiation of a process of self-transformation in which lucid self-knowledge and acceptance are combined into a process that allows full self-development.

The Impact of Sexual Orientation on Women's Midlife Experience: A Transition Model Approach

Sexual orientation is an integral part of identity affecting every stage of an individual's development. This literature review examines women's cultural experiences based on sexual orientation and their effect on midlife experience. A developmental model is offered that incorporates sexual orientation as a contextual factor in this developmental stage. ********** The 2000 census revealed that, out of a total population of more than 281.4 million people, 96 million were middle-aged adults between the ages of 35 and 60. Of this number, more than 49 million were (U.S. Census Bureau, 2001). Adults entering their middle years experience a number of developmental transitions in common, such as retirement, children leaving home, losing a partner (through divorce or death), serious personal illness, and the possibility of caring for aging relatives (Astbury-Ward, 2003; Ballard, Kuh, & Wadsworth, 2001; Schlossberg, Waters, & Goodman, 1995). Although both men and face the prospect of changing roles at this developmental stage of life, middle-aged may have more difficulty transitioning from who they have been to who they are becoming. Mothers become grandmothers, wives become widows, and, often, who have spent the majority of their adult lives as caretakers and homemakers find themselves entering the workforce, either for the first time or after a considerable absence. Socially, they are subjected to the negative expectations, assumptions, and biases imposed upon women by modern Western society (Astbury-Ward, 2003; Ballard et al., 2001; Degges-White, 2001; Shore, 1999), which may create additional social and emotional conflict for some as they approach their middle years. Sexual orientation, too, plays a part in how a woman processes her midlife experiences, because her sexual expression and conformity or nonconformity to traditional gender roles affect how she is seen and, therefore, how she sees herself in society throughout her life (Grossman, 1997). According to estimates by the National Gay and Lesbian Task Force Policy Institute, approximately 3% to 8% of the U.S. population identifies as lesbian or gay (Cahill, South, & Spade, 2000). Using that figure as a guideline, and based on the current population of middle-aged cited earlier, there are between 1.47 and 3.92 million middle-aged lesbian living in the United States today. Despite the significance of their numbers, the current literature on the midlife and aging of lesbians devotes little effort to understanding the unique needs and concerns of this population (Orel, 2004). This article presents a literature review that explores the context in which both heterosexual and lesbian experience some of the changes intrinsic to midlife as a developmental stage and how those changes are affected by sexual orientation. A developmental model is presented that counselors may use in conjunction with a variety of theoretical orientations to address each woman's personal experience of this developmental transition from her unique perspective, using sexual orientation as but one aspect of a multifaceted, multicultural identity. Implications for therapeutic use of the model are also discussed. SOCIAL CONSTRUCTS OF AGING AND MENOPAUSE A number of researchers have posited that women's experience of menopause and midlife is culturally constructed (Astbury-Ward, 2003; Degges-White, 2001; Gabbay & Wahler, 2002; Shore, 1999; Winterich, 2003) and that whether they view midlife changes as positive, negative, or neutral may be culturally determined (Astbury-Ward, 2003). Degges-White suggested that, in fact, in the United States often anticipate a negative experience of menopause, and of midlife in general, because they are preprogrammed by the societal stigma attached to older women. Women are under more pressure than men to maintain a youthful appearance (Astbury-Ward, 2003) and are perceived as older sooner than men (Ballard et al. …

Midlife concerns and short‐term personality change in middle adulthood

In this study, it was expected that personality change would be related to parents' concerns in various domains of midlife functioning. Personality was found to be moderately stable, but small but reliable change was also found. Fathers' change in personality was uniquely related to their life satisfaction, work stress and perceptions of the level of their adolescent children's internalising problems, but not to perceived partner support. By comparison, mothers' change in personality was only uniquely related to their life satisfaction. These results suggest that personality change in midlife is associated with the successful adaptation to midlife concerns. This pattern is consistent with social investment theories of personality development, though cross‐lagged longitudinal research is needed to substantiate this conclusion. Copyright © 2006 John Wiley &amp; Sons, Ltd.

Menopause Symptoms and Attitudes of African American Women: Closing the Knowledge Gap and Expanding Opportunities for Counseling

Menopause a normal midlife transition for women, remains poorly understood, especially for minority women. A total of 226 African American midlife women completed the Menopause Symptoms List (J. M. Perz, 1997); Menopause Attitude Scale (C. Bowles, 1986); Attitudes Toward Menopause checklist (B. L. Neugarten, V. Wood, R. J. Kraines, & B. Loomes, 1963); and instruments to elicit information about health status, stressful life events, social support, and demographics. The results reveal strengths as well as areas of concern for African American women in responding to normative midlife changes. Implications for counselors are explored.

Development in midlife.

The midlife period in the lifespan is characterized by a complex interplay of multiple roles. The goal of this chapter is to summarize research findings on the central themes and salient issues of midlife such as balancing work and family responsibilities in the midst of the physical and psychological changes associated with aging. The field of midlife development is emerging in the context of large demographic shifts in the population. A section on the phenomenology of midlife development presents images and expectations including the seemingly disparate views of midlife as a time of peak functioning and a period of crisis. Conceptual frameworks useful for studying the multiple patterns of change in midlife are presented. Findings demonstrating patterns of gains and losses are reviewed for multiple domains: cognitive functioning, personality and the self, emotions, social relationships, work, and physical health. The need for future research to illuminate and integrate the diverse aspects of midlife is highlighted.

Clinical review 162: cardiovascular endocrinology 3: an epidemiologist looks at hormones and heart disease in women.

More than 100 yr ago, Osler (1) noted that heart disease was almost entirely a disease of men. Fifty years ago, the most popular explanations for sex differences in heart disease were lifestyle, particularly cigarette smoking (which was mainly a male habit until World War II), or differences in stress (i.e. men in the workforce and women at home, or what I like to call the “happy homemaker hypothesis”) (2). Although behavior and occupation differences may play a role, neither has emerged as a satisfactory explanation for women’s favored cardiovascular status. As shown in Fig. 1, women in every country, whether heart disease rates are high or low, are at lower risk of fatal coronary heart disease (CHD) compared with men, despite diverse lifestyles, diets, and workplace options (3). Indeed, within countries women have less heart disease than men when stratified by similar levels of classical heart disease risk factor levels. In the Renfrew and Paisley Survey (4), for example, sex-specific coronary death rates separately adjusted for cholesterol, blood pressure, body mass index, cigarette smoking, and social class showed that women had lower absolute rates at every age, although the relative risks associated with these risk factors were similar. This is also true for one factor that differs by sex, i.e. women’s higher high-density lipoprotein (HDL) cholesterol levels; within the same HDL strata, women have less heart disease than men (5). These results between and within populations and consistent across risk factors support the hypothesis that women are protected by an intrinsic factor, presumably female sex hormones. Several types of epidemiological evidence suggest that women’s universal protection against CHD is explained by estrogen (6, 7). The main observations are that CHD is 1) uncommon in women before the age of menopause, 2) more common in women who have a premature natural menopause, 3) more common in young women who have had both ovaries removed, and 4) less common in women who take hormone therapy (HT) after menopause. Population-based evidence that heart disease death rates increase after menopause is actually weak. An exponential increase in heart disease rates by age as observed in standard plots becomes a step-wise linear association when heart disease death rates are plotted on a semilogarithmic scale. There is no evidence of a different slope around age 50 yr, the usual age at menopause, as shown in Fig. 2 (8). As also shown in Fig. 2, this is in striking contrast to the midlife change in the semilogarithmic slope for breast cancer, an estrogen-dependent disease. These results could mean that estrogen is not such a primary player in heart disease etiology as it is for breast cancer, or that heart disease has a much more multifactorial etiology, making it more difficult to observe estrogen’s central role, or that estrogen is not the intrinsic factor. Some prospective epidemiological studies of individual women have shown small albeit significant associations of cardiovascular disease death with age at natural menopause (9, 10). These types of studies of menopause-CHD associations could be weak because the last menstrual period may not be accurately noted or because the lag to clinically manifest CHD is highly variable, because coronary disease has many other contributing risk factors. Note that these associations could also be an artifact due to confounding by cigarette smoking, the commonest cause for premature menopause and a powerful CHD risk factor. If premenopausal estrogen levels are cardioprotective, then premature menopause, with fewer years of exposure to premenopausal estrogen levels, should magnify risk. As reviewed elsewhere (6), many autopsy studies have demonstrated an excess of coronary artery atherosclerosis in young women who have had an oophorectomy. However, these observational studies of surgical menopause could be confounded by each woman’s reason for or reaction to early menopause, the reason for the autopsy, and possibly by the concomitant loss of other hormones (e.g. testosterone) after oophorectomy. Theoretically, studies of endogenous estrogen levels and Abbreviations: CEE, Conjugated equine estrogen; CHD, coronary heart disease; CI, confidence interval; HDL, high-density lipoprotein; HERS, Heart and Estrogen/Progestin Replacement Study; HT, hormone therapy; IMT, intimal medial thickness; LDL, low-density lipoprotein; MI, myocardial infarction; MP, micronized progesterone; MPA, medroxyprogesterone acetate; WHI, Women’s Health Initiative. 0021-972X/03/$15.00/0 The Journal of Clinical Endocrinology & Metabolism 88(9):4031–4042 Printed in U.S.A. Copyright © 2003 by The Endocrine Society doi: 10.1210/jc.2003-030876

Symptom experience in Australian men and women in midlife

O bjective: To compare the experience of vasomotor, psychological and somatic symptoms in Australian men and women in midlife, to investigate whether symptoms often attributed to endocrine changes in midlife are associated with health and psychological well-being, and to evaluate their relationship to menopausal status in women. Methods: A cross-sectional, correlational, population-based study based on self-report questionnaires. Participants comprised 451 men and 766 women, aged between 39 and 65, from urban and rural South Australia, who responded to invitations to participate, or who volunteered to participate following media releases. Outcome measures used comprised a 47-item symptom checklist of current presence and severity of vasomotor, somatic and psychological symptoms experienced by men and women during midlife, and measures of health and psychological well-being. Results: The majority of men and women reported that they were not ‘bothered’ by vasomotor, psychological and somatic symptoms. For those symptoms in which men and women differed significantly, women generally reported being more ‘bothered’ than men, although the pattern of association between symptoms and measures of health and psychological well-being was the same for both men and women. Items from all three symptom clusters were independently related to menopausal status. Conclusions: Health and psychological well-being play a role in the genesis of symptoms experienced by men and women in midlife. Both men and women experience similar symptoms, although women are more distressed by them signifying support for a menopausal syndrome in women. The finding of an independent relationship between menopausal status and psychological and somatic symptoms, in addition to the vasomotor symptoms, contradicts the narrow-estrogen hypothesis of climacteric symptoms.

Conceptualizing Transition: The Role of Metaphor in Describing the Experience of Change at Midlife

Five new or returning midlife university students were asked to provide metaphors describing their experience of midlife change, change indicated by their attending university at this point in their lives. Five resulting portraits (S. Lawrence-Lightfoot & J. H. Davis, 1997) were created, based on participant-invoked metaphors: personal rebellion against colonization, stage productions, collection and accumulation, journey home, and alchemy and metamorphosis. The portraits indicate that even from within widely divergent metaphoric conceptualizations, the respondents all find midlife to be an active, positive, and hopeful period of life. For them midlife is decidedly neither crisis nor dull plateau. Further, given the richness of the metaphor use, the study demonstrates the desirability of listening carefully to and moreover expressly soliciting metaphoric usage, in order to more fully understand people's inner realities. Finally, the portraits reveal that the participants' metaphoric conceptions are deeply imbedded in their lives, past and current, and as such identify life themes.

Personality Development Across the Life Course:The Argument for Change and Continuity

In this article we review answers to 5 questions concerning the development of personality across the life course: How early in the life course can we identify characteristics unique to individuals that will show continuity over time? When in the life course is personality fully developed? What life course factors moderate continuity and change in personality? What are the mechanisms that promote continuity in personality? And finally, what are the mechanisms that promote change in personality? Based on the answers to these 5 questions we conclude (a) that there is modest continuity from childhood to adulthood, (b) that personality traits do not become fixed at a certain age in adulthood and retain the possibility of change even into old age, and (c) that with time and age people become more adept at interacting with their environment such that personality consistency increases with age and is more common than change in midlife and old age.

Modifiable risk factors and erectile dysfunction: can lifestyle changes modify risk?

Objectives. To prospectively examine whether changes in smoking, heavy alcohol consumption, sedentary lifestyle, and obesity are associated with the risk of erectile dysfunction. Methods. Data were collected as part of a cohort study of a random sample of men 40 to 70 years old, selected from street listings in the Boston Metropolitan Area, Massachusetts. In-home interviews were completed by 1709 men at baseline in 1987 to 1989 and 1156 men at follow-up in 1995 to 1997 (average follow-up 8.8 years). Analyses included 593 men without erectile dysfunction at baseline, who were free of prostate cancer, and had not been treated for heart disease or diabetes. The incidence of moderate to complete erectile dysfunction was determined by discriminant analysis of responses to a self-administered sexual function questionnaire. Results. Obesity status was associated with erectile dysfunction ( P = 0.006), with baseline obesity predicting a higher risk regardless of follow-up weight loss. Physical activity status was associated with erectile dysfunction ( P = 0.01), with the highest risk among men who remained sedentary and the lowest among those who remained active or initiated physical activity. Changes in smoking and alcohol consumption were not associated with the incidence of erectile dysfunction ( P >0.3). Conclusions. Midlife changes may be too late to reverse the effects of smoking, obesity, and alcohol consumption on erectile dysfunction. In contrast, physical activity may reduce the risk of erectile dysfunction even if initiated in midlife. Early adoption of healthy lifestyles may be the best approach to reducing the burden of erectile dysfunction on the health and well-being of older men.