Human development is mapped out throughout the lifespan. The life stage of ‘Middle Adulthood’ is used to explain individuals aged 40-65 years (Hoffnung et al 2016). This stage of middle adulthood in human development is characterized by aging changes in the body, with cognitive processes involving fluid intelligence decreasing while crystallized intelligence remains. Family and friend relationships evolve with those with children experiencing transitions of roles and responsibilities. All these changes mean that the body becomes more prone to illness and disease, with coronary heart disease acting as a leading cause of death for those aged 40-65 (Australian Institute of Health and Welfare 2018). This disease has many life-changing impacts on those it affects, with adults having to transform their old unhealthy lifestyles into a new normal. Both Erikon’s psychoanalytic theory and Wilson’s sociobiological theory can be used to explain the prevalence of coronary heart disease in middle adulthood, with each theory having benefits and limits in doing so. Diversity and variation are seen in gender and ethnicity, with coronary heart disease impacting primarily males rather than females, and Aboriginal and Torres Strait Islanders than non-Indigenous Australians.
The life stage of ‘Middle Adulthood encompasses various changes with biological, psychological, and social changes, particularly apparent during this stage. Biological changes accompany this stage in the form of primary and secondary aging, leading to the rise of possible risk factors and the prevalence of chronic disease (Valentine-French, S. & Lally 2019). Primary aging involves tissue and muscle degradation, cardiac functioning, and decreasing of respiratory and sensory abilities [hearing and vision] (Boundless Psychology 2015)
Morbidity and mortality rates increase during middle adulthood, thus an emphasis is placed on maintaining a healthy and active lifestyle (Villarreal & Heckhausen 2015). A decline in fertility is apparent with reproductive capacity and sexual decreases experienced (Fernandez 2010). The deterioration of the prostate is experienced by men, while menopause is experienced by women. Additionally. psychological changes refer to cognitive thinking processes and problem-solving. Cognitive processes slow down during this life stage, with fluid intelligence which involves basic-information processing skills declining during middle adulthood (Boundless Psychology n.d, Vinney 2019). On the other hand, crystallized intelligence increases, which involves “the ability to use the knowledge that was previously acquired through education and experience” (Vinney 2019). It is important to engage in mentally and physically stimulating activities which results in “less cognitive decline in later adult years and have a reduced incidence of mild cognitive impairment and dementia” (Hertzog, Kramer, Wilson, & Lindenberger 2009). During this time, many adults are focused on a particular field of employment, thus their knowledge and intelligence reflect their employment and working life (Hoffnung et al 2016). Burnout can be experienced by individuals during this stage, which refers to “disillusionment and exhaustion on the job that may result from stress caused by multiple role commitments, discrimination based on ethnicity, gender or other factors” (Hoffnung et al 2016, p566). The social changes that occur during middle adulthood surround the impact of marriage and divorce and changes in family relationships and structures (Fernandez 2019). Aging adults undergo personal growth and change with family relations shifting as children become less reliant on their parents. This can lead to feelings of isolation, loneliness, loss, and guilt as a result, yet this provides an opportunity for renewed independence and identity in a newfound freedom.
Coronary heart disease (CHD) is a prime health issue experienced by those in middle adulthood with it being the first leading cause of death for those aged 45-64 (Australian Institute of Health and Welfare 2018, p3). The prevalence of coronary heart disease increases with age as “five percent of Australians aged 55-64 reporting a long-term CHD condition” (The Heart Foundation 2014). It is the leading cause of death for males (13%) and 10% for females (AIHW 2018). Coronary heart disease occurs when the arteries become narrow and clogged due to plaque build-up, which reduces blood flow to the heart. Further, this plague can create a crack on the surface of the arteries, resulting in blood cells clotting in an attempt to seal the gap in the artery. Pain and discomfort experienced as a result of narrow arteries that limit the blood flow to the heart is referred to as angina. Angina caused by blocked coronary arteries happens abruptly and becomes worse gradually, indicating a higher risk of heart attack (The Heart Foundation 2019). A heart attack occurs as a result of blood clotting that blocks the flow of blood, or due to a reduced flow of blood to the heart muscle due to narrow arteries (Heath Direct 2017). Individuals in the middle adulthood age group are more prone and have a higher chance of developing this disease (Australian Bureau of Statistics 2018). Nonmodifiable factors that are unchangeable contribute to the development of this disease, including family history, gender, ethnic background, and age. Modifiable factors that are changeable, include are mostly lifestyle choices including smoking, high blood pressure/cholesterol [hypertension], diabetes, being inactive, obesity or being overweight and social isolation (The Heart Foundation 2019). The prevalence of modifiable risk factors rises with age, which increases the likelihood of individuals in the 40-65 age bracket developing coronary heart disease. For example, “the proportion of people with hypertension tripled from age 35-44 years (4.2%) to 45-54 years (12.9%)” (AIHW 2018). Additionally, “The population of smokers is aging and the majority (57%) of daily smokers in 2016 were aged 40 and over” (AIHW 2018). As those in the life stage of middle adulthood are most likely to be impacted by this health issue, their lives can radically change as a result of living with this heart condition. There is a link between anxiety, depression, and CHD (Beyond Blue 2014), with mental health linked to unhealthy coping mechanisms that can contribute to an unhealthy lifestyle. Further, this hinders lifestyle changes required to recover and permeates the motivation required to create change. Coronary heart disease inhibits one’s participation in daily life, preventing one from engaging in regular activities that could induce heart pain and pressure caused by angina. This can affect relationships with family and friends which is important for individuals in this life stage. For example, individuals in the life stage can become grandparents yet having CHD would limit their ability to enjoy and participate in activities with grandchildren. This can result in a change of attitude towards life in having to transition into a modified life, with feelings of hopelessness, uncertainty, desperation, a sense of vulnerability, and pessimism becoming a result (Najafi Ghezeljeh et al 2014). In addition, the absence of physically stimulating activities can increase cognitive aging, having a domino effect on an individual's health, and halting positive development required that increase overall well-being through the final stages of life (Gilbert 2017).
Theories to explain coronary heart disease in middle adulthood:
Erik Erikson’s ‘Psychosocial theory’ addresses human development through “infancy to late adulthood on the basis of biologically and culturally determined timing” (Cheng 2009). Throughout this process, the ego/self is developed with each stage in the lifespan involving a crisis in personality that is important at that particular time in maturation that must be resolved for healthy ego development (Fernandez 2016 p28). Conflicting and competing positive and negative tendencies. The resolution of ego conflicts is essential in an individual's development as the “resolution of later crisis/conflicts depends on the outcome reached in previous stages” (Malone et al 2016). Virtue is the successful outcome of the stage in development (Fernandez 2016). According to Erikson, the life stage of middle adulthood involves the competing tendencies of ‘generativity vs stagnation’ (Cherry 2019). In this, individuals are “concerned for establishing and guiding the next generation” (Malone et al, 2016). The struggle between the need to feel a sense of accomplishment in their actions toward society and a sense of failing to contribute to society is experienced during this stage (Cherry 2019). Generativity refers to a sense of meaning and purpose that one creates “through creating or nurturing things that will outlast an individual” (McLeod 2018). Generativity has a considerable effect as it “forms the foundation for a sense of completeness and coherence in old age” (Cheng 2009) and “promotes psychological well-being” (Adams & Logan 2004). The resolution of these two consequences can have substantial effects on the quality of life for the adult. In addition, this stage is significant acting as a turning point in determining one's influence and mortality, “Mature adult is concerned with establishing and guiding the next generation or else feels personal impoverishment” (Boundless Psychology n.d). Stagnation refers to limited growth and feeling unproductive, meaningless, despite. According to Lally & Valentine-French (2019), “not feeling needed or challenged may result in stagnation, and consequently one should not fully withdraw from generative tasks as they enter Erikson’s last stage in late adulthood”. The resolution of this crisis results in the renewed virtue that is the successful outcome of the stage in development, which is care (Malone et al 2016). In this, the focus is shifted concentrated on “take care of the persons, the products, and the ideas one has learned to care for” (Erikson, 1982, p. 67). This is useful in explaining the impact of coronary heart disease on individuals in middle adulthood as care in the physical sense and emotional dimensions are important in averting the possibility of developing coronary heart disease. While this can be interpreted in this way, the theory specifically focuses on the psychological aspects that occur throughout the development during the lifespan. Due to this, the biological changes that occur are not focused on, with social and cultural influences and development being the main focus. When generativity acts as the resolution, this can influence the way that the individual treats and looks after their body, as they believe they are needed and important to others.
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The sociocultural/evolutionary theory proposed by E.O. Wilson “explores how human behavior is influenced by underlying biological and genetic characteristics as well as cultural learning” (Johnson 2008). In this, humans are explained through the conjunction of biology/genetics and sociocultural environments, with “places a great deal of weight on the environment to which a person must adapt” (Liebermann 2007). By understanding the interactions between one's biology and the environment, one can see how certain behaviors are developed (Driscoll 2018). This theory is useful in reference to coronary heart disease that is experienced during middle adulthood, as the disease is largely the result of genetic dispositions and its interactions and decisions made within the environment. In following this theory, it can be said that our biological imprints guide the physical processes that enable positive health and well-being. The body’s aversion to certain bad lifestyle choices has evolved to protect the heart from toxic substances (Hoffnung et al 2016). The reaction of the heart, particularly seen during angina, signals of what the body requires and does not require to function properly. Further, the capacity of the physical body at this life stage means that maintaining a high level of health is essential for survival, as the body is not able to handle such high levels of unhealthy substances.
Additionally, this theory is valid when looking at the interactions between physical and social factors that both contribute to the outcome of health issues, with genes acting as the basis of human behavior. However, the prime focus on genes and biology as the basis of behavior undermines the influence of social interferences on health outcomes (Fernandez 2016). While coronary heart disease in middle adulthood can be the result of genetic predispositions and family history, it is also largely the result of bad lifestyle habits. When looking at explaining coronary heart disease, it is evident of the primary risk factors including lifestyle, diet, high blood pressure, obesity, and smoking, are a result of external life choices and behaviors (The Heart Foundation 2019). The various social influences and certain upbringings in a social environment can create a foundation for one's knowledge of nutrition and health (Driscoll 2018). The complexity of social influence that regulates some behaviors is not fully recognized.
Diversity is apparent when looking at the prevalence of coronary heart disease in middle adulthood. In particular, when referring to gender and ethnicity, distinct gaps are visible. Generally, it is apparent that “men are more likely to get sick from serious health problems than Australian women” (Better Health 2018). This can be due to physiological influences; genes, hormones, and anatomy (Better Health 2018). These health outcomes are also largely the result of socially constructed behavioral expectations, with men more likely to participate in risk-taking behaviors: including smoking, alcohol consumption, and unhealthy lifestyles. The combination of these factors results in higher rates of disease, as experienced by males. When looking at gender in the context of CHD, there is a higher prevalence of coronary heart disease experienced by males than females. The disease is responsible for 13% of deaths in males and 10% in females. The majority of patients admitted health expenditure is spent on males, who cover 70% of total patient expenditure in this area. According to Fodor & Tzerevska (2004), “Men develop CHD approximately 10 to 15 years earlier than women”. Men experience higher rates of the various modifiable risks which lead to coronary heart disease. Males have higher rates of smoking tobacco than women, with those aged 40–49 being the age group most likely to smoke daily (16.9%) (Australian Institute of Health 2018). Men have higher rates of obesity and being overweight than women, with a “higher prevalence of abdominal obesity in men increasing their risk for CHD” (Fodor & Tzerevska 2004). Further, men have a higher rate of type 2 diabetes than women, specifically from ages 45 onwards (Australian Institute of Health 2018). All of these modifiable risk factors result in the development of coronary heart disease. It is further evidence that during middle adulthood, individuals are more likely to develop various health problems that contribute to the onset of coronary heart disease.
It is apparent that there is a distinction between Aboriginal and Torres Strait Islanders and non-Indigenous Australians when looking at the prevalence of coronary heart disease. According to AIHW (2019), Aboriginal and Torres Strait Islanders experience higher rates of hospitalization due to coronary heart disease as compared to other Australians. Aboriginal and Torres Strait Islanders were substantially more likely to suffer from heart attacks “ to die from it without being admitted to hospital, and to die from it if admitted to hospital” compared with other Australians. Further, nearly half of the individuals in middle adulthood experience cardiovascular disease as “around four in ten (42%) of those aged 55 years and over” experience CVD, with coronary heart disease being the leading cause of death (Australian Indigenous HealthInfoNet 2019, p9-10). Indigenous Australians have 3 times the rate of major coronary events such as heart attacks (AIHW 2018). This is the result of the normality of the risk factors that result in coronary heart disease, particularly smoking, diabetes, obesity, high blood pressure, and cholesterol (Australian Indigenous HealthInfoNet 2019). Additionally, the lack of quality health care received by Indigenous peoples contributes to the higher rates of death caused by coronary heart disease. Coronary heart disease requires intense care to manage and reduce symptoms, however Aboriginal and Torres Strait Islander people are less likely to receive necessary clinical care than non-Indigenous people (Australian Indigenous HealthInfoNet 2019). This reflects larger gaps in inequality regarding health care received by Indigenous Australians.
In reference to Erikson’s model of psychosocial development, the life stage of ‘Middle Adulthood’ is used to explain individuals aged 40-65 years (Hoffnung et al 2016). There is a “high degree of variability within age periods, in terms of health, well-being, and functioning” (Lachman, Margie E et al). During the life stage of Middle Adulthood, coronary heart disease is one of the main health issues and one of the highest killers for adults. Through the use of Erikson’s psychosocial theory and evolutionary theory in relation to the impact of coronary heart disease on individuals in middle adulthood. Diversity regarding coronary heart disease in middle adulthood varies, in particular, gender and ethnicity reveal disproportional experiences.
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