13.4: Maintaining Health and Well-Being in Middle Adulthood
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Learning Objectives
By the end of this section, you will be able to:
- Identify major health concerns of middle adulthood
- Describe behaviors and lifestyle choices that promote well-being
- Identify the psychologically relevant features of work, career, and work-life balance
Carson remembers her twenties well. She was proving herself in a stressful job and frequently grabbed a quick (and not necessarily healthy) meal to eat at her desk while working late. She would leave the office around 7 or 8 p.m., meet up with friends at a local hangout, sleep for five or six hours, and wake up to do the same the next day. Fast-forward twenty years, and Carson is a forty-five-year-old mother of two school-age children and is also looking after older parents who have age-related health issues. She and her spouse are not close to retirement, but they enjoy thinking about the trips they’ll take together someday when they have more time and freedom. She wants to be there—and be healthy—on those trips, and she wants to live as long as possible to enjoy future generations of her family. She knows she needs to make some lifestyle changes to make that more likely.
Around age forty years, many individuals become more aware of aging and longevity, as has occurred with Carson. Health-care providers add more tests at routine checkups, and while mortality in middle age isn’t common, most people know someone who died younger than expected. As individuals enter this life stage, they begin to think more about what constitutes a healthy lifestyle and how to achieve their health goals.
Health Concerns in Middle Adulthood
Until middle adulthood, the leading cause of death is unintentional injury due to accidents. However, between the ages of thirty-five and sixty-four years, the leading cause of death shifts from accidents to health-specific issues like cancers and heart disease (Figure 13.14) (Centers for Disease Control and Prevention [CDC], n.d.a). Learning how cancer, cardiovascular disease, and metabolic and endocrine disorders become health issues to monitor in middle adulthood can help you make choices that promote healthy living and support an enriching life.
Cancer
Cancers form when the body’s normal elimination of old cells is disrupted, and damaged cells continue to reproduce. Numerous risk factors are associated with the development of cancer s, including genetics, lifestyle, and environmental influences. However, the most significant risk factor for cancer is aging, as shown in Figure 13.15. The ten most diagnosed cancers in the United States have an average age of diagnosis of sixty years or older; the average age of all cancer diagnoses is sixty-six years (National Cancer Institute, 2021).
In 2020, the National Cancer Institute (NCI) identified the increasing incidence of certain early-onset cancers (defined as those diagnosed at age fifty years or younger) as an emerging research priority. In particular, the NCI wants to know why certain cancers, such as breast cancer, colorectal cancer, thyroid cancer, and pancreatic cancer, are occurring increasingly earlier in life, and to develop better procedures for early detection (NCI, 2020). Some of these cancers may not be increasing in occurrence but rather are being detected and diagnosed earlier due to an increase in screening. However, researchers are also investigating whether people are being exposed to more risk factors early in life. Early correlational research has identified alcohol use, antibiotics, obesity, sedentary lifestyle, low sleep quality, smoking, diabetes, and a diet high in saturated fats, red meat, sugar, and processed foods as possible risk factors; however, more experimental research is needed to draw conclusions about cause and effect (Ugai et al., 2022). Additionally, research into cultural differences shows that the absence of education and limited access to screening tools such as mammography, breast self-examination, and inconsistent health care can contribute to the early onset of some cancers. For instance, Badr and colleagues (2018) found that Lebanese women aged forty to forty-nine years were more likely to develop more aggressive forms of breast cancer at younger ages compared to women in Western and Middle Eastern countries but were less aware of the availability and preventive value of breast cancer screening. 3
Life Hacks: Cancer Prevention
Cancer can happen to anyone, regardless of age, and it can be caused entirely by factors outside an individual’s control, such as biological aging, genetic predisposition, and environmental contaminants. However, based on studies of modifiable risk factors, meaning those over which an individual has some control, scientists and doctors make several recommendations to reduce cancer risk (NCI, 2023). Here are a few of these recommendations:
- Quit smoking or don’t smoke. Cigarette smoking is the leading cause of preventable disease and death in the United States and accounts for 30 percent of all cancer deaths. Smoking is most common among midlife adults and is higher among those with low education and low income (CDC, 2023a).
- Ask your doctor about vaccines that prevent viruses associated with cancer, including the human papillomavirus (HPV) vaccine (which reduces risk of cancers of the cervix, penis, vagina, and anus) and the hepatitis B vaccine (which reduces risk of liver cancer).
- Adopt healthy dietary and drinking habits . Eating a low-fat, high-fiber diet reduces the risk of colorectal cancer. Decreasing alcohol consumption lowers the risk of various cancers, including oral and esophageal cancers.
Link to Learning
Nicotine is one of the active ingredients in cigarettes and other tobacco or vaping products linked to lung and other cancers, and it is considered highly addictive. According to the National Institute on Drug Abuse, most adult smokers want to quit but are unsuccessful in doing so.
In this video, learn how cigarettes harm us and whether our bodies can recover if we stop.
If you or someone you know wants to quit smoking, the CDC’s tips for quitting smoking may be able to help.
Cardiovascular Disease
While cardiovascular disease ( CVD ) is not random, it can often be unexpected. Among the contributing factors is hypertension or high blood pressure, which occurs when the blood pushes against the artery walls with high force. Another factor that increases risk of CVD is high cholesterol (Figure 13.16). Cholesterol is a component of cell membranes made up of proteins and fats. High-density lipoprotein (HDL) is considered good cholesterol and cycles through the blood and liver. Low-density lipoprotein (LDL) is considered problematic, because if present in high amounts, it will stick to the lining of blood vessels. This buildup hardens the walls of the arteries and increases CVD and stroke risk. High levels of triglycerides, which are fats that can build up as plaque in the arteries, also increase the risk of heart disease (Curfman, 2019).
Men and women have different experiences with CVD. Men have more overall occurrences of and fatalities from CVD. However, following a heart attack, women typically remain in the hospital longer than men and are more likely than men to be readmitted to the hospital for heart-related symptoms within the year following an initial heart attack (American College of Cardiology, 2023; Bosworth et al., 2000; Suman et al., 2023). Heart attack symptoms also vary between men and women, as shown in Figure 13.17. Men’s symptoms include chest pain, lightheadedness, stomach pain, and shortness of breath. Women’s symptoms include back and neck pain, anxiety, dizziness, and shortness of breath (Katella, 2023).
Unintentional Injuries
Unintentional fatal injuries are most often caused by accidental poisoning/drug overdoses, motor vehicle accidents, drowning, and falls. The leading cause of drug overdose deaths is from opioids, used either illegally or through prescription overuse or misuse (CDC, 2024a). Fatality risk for opioid overdose is highest between ages forty and fifty years (Dydyk et al., 2024). While the rate of opioid fatalities is on the rise, this alarming trend can be addressed through more careful monitoring of prescribed opioids and treatment for opioid dependence (CDC, 2024a). The number of motor vehicle crash deaths has decreased substantially in the last several decades due, in part, to the increased use of seat belts by drivers and passengers (Insurance Institute for Highway Safety, 2024).
Body Weight and Diabetes
Body mass index ( BMI ) is a height-for-weight measurement calculated by dividing a person’s weight by their height. According to the World Health Organization (WHO), if the resulting BMI is thirty or higher, the person has obesity (WHO, 2021). The rate of obesity increases in middle age, given age-related loss of muscle to fat and a typically slower metabolic rate. In the United States, 44 percent of adults forty to fifty-nine years of age are obese, with rates somewhat higher among Black adults (49 percent) and lowest among Asian adults (16 percent) (CDC, 2024b). That said, BMI alone is considered an imperfect measure of general health; it is best interpreted in the context of other individual health indexes as well as a person’s gender, age, race, and ethnicity (Berg, 2023).
Obesity is generally associated with an increased risk of high blood pressure. Obesity is also associated with a higher risk of cancer (American Cancer Society, 2023) and insulin resistance. Insulin is a hormone that helps the body convert blood sugar into energy, thereby regulating blood sugar levels. If body cells become resistant or unresponsive to insulin, chronic high blood sugar may result. Metabolic syndrome is a related condition in which obesity and insulin resistance interact to increase risks of heart disease, stroke, and diabetes.
Diabetes is an easily diagnosable chronic condition in which the pancreas fails to produce enough insulin to break down sugar in the bloodstream. Type 2 diabetes is known as adult-onset diabetes, and risk factors include family history, age, weight, and sedentariness. The risk of fatality from diabetes increases with age. In 2020, more than 500,000 middle-aged adults died from complications of diabetes (CDC, 2024e), and the disease disproportionately affects minority groups (CDC, n.d.b). The chronic nature of poorly regulated diabetes causes complications such as kidney failure, retinopathy, and neuropathy (nerve damage), particularly in the legs and feet. Type 2 diabetes can be managed in the long term through a combination of a low-sugar diet, regular exercise, and prescribed medications to control blood glucose levels.
Warning signs that precede the onset of type 2 diabetes can provide opportunities for prevention. Prediabetes is a condition in which the blood sugar level is higher than normal but not high enough to be considered type 2 diabetes. More than one-third of all U.S. adults are prediabetic, but most do not know it. Early detection of prediabetes is important, because a doctor-recommended change to diet, exercise, and weight management can prevent the progression to type 2 diabetes (CDC, 2024d).
Link to Learning
Want to learn more about your risk for type 2 diabetes and how lifestyle changes to diet and exercise can help prevent and manage this chronic disease? The Centers for Disease Control and Prevention offer a free online Prediabetes Risk Test so you can learn more.
Stress
Midlife is full of stress ors, such as career responsibilities; the demands of raising children; aging parents who might need assistance; and financial responsibilities like rent or mortgages, car loans and credit card debts, and the desire to save for personal retirement or children’s future needs. Stress is also a risk factor for CVD . In the 1950s, cardiologists Meyer Friedman and Ray Rosenman proposed a link between CVD and the way stress is conveyed in personality (1959). The personality types they proposed were based on individual differences in the experience of stress. Type A individuals were said to be ambitious, competitive, driven, and more easily alarmed—traits deemed more predictive of CVD than the relaxed and patient qualities of type B individuals. Later work also proposed type C, passive people pleasers (Rymarczyk et al., 2020), and type D, those with greater degrees of anger and hostility (Denollet, 1997; O’Dell et al., 2011). Of all the characteristics, higher hostility appears to be the strongest predictor of CVD.
To help conceptualize how stressors influence overall physical health, researchers have come to use the concept of allostatic load (Figure 13.18). The allostatic load is the cumulative health toll of stressors, including the body’s biological response (activation of the sympathetic nervous system and release of stress-response neurotransmitters and hormones), as well as secondary health impacts, such as changes in sleep, diet, and substance use patterns (Guidi et al., 2020; McEwan & Seeman, 1999). Allostatic load is often used as a biological indicator of physiological dysregulation due to cumulative wear and tear from chronic stress. High allostatic load is associated with aging effects, such as earlier cognitive declines (D’Amico et al., 2020; Lenart-Bugla et al., 2022; Seeman et al., 1997) and increased mortality (Parker et al., 2022). Specifically, in a recent meta-analytic review, researchers found a 22 percent increased overall mortality risk. They also found a 31 percent increased mortality risk associated with cardiovascular disease. (Parker et al., 2022). Adults who experience chronic inequality—particularly people of color, women, and those living in poverty—are more likely to report experiencing upsetting stressors in a variety of domains, including finances, work, relationships, and health (Wang et al., 2023). Furthermore, middle-aged adults with depression who experience higher allostatic load were at greater risk of cognitive decline (Perlman et al., 2022). Those with intersectional identities are at greatest risk of accumulating a higher allostatic load and the associated aging effects, through a process that Geronimus and colleagues (2006) described as “weathering.” “Intersectional identities” is a term used to describe individuals who might experience multiple marginalized identities. For example, when the weathering hypothesis was first introduced it was used to describe the way health declines may impact African American women earlier than non-Hispanic White women due to the cumulative risks associated with experiencing socioeconomic disadvantage (Geronimus, 1992). Current research continues to find evidence of the weathering hypothesis in groups who experience social or economic disadvantage (Forde et al., 2019).
Well-Being in Middle Adulthood
Living a healthy and satisfying lifestyle is important at all ages of life, but it is sometimes easier said than done. Many adults struggle to start and maintain healthy habits as they juggle daily and significant life stressors in midlife. Social support, stress management, and healthy approaches to diet, activity, and sleep can all support well-being.
Social Support and Engagement
According to the stress-buffering effects model (Castillo, 2016), social support can protect adults from stress in three ways:
- When we feel supported by others, we are less likely to perceive situations as stressful.
- Social support reduces our body’s physiological response to stress.
- Others can provide us with resources for coping with stress.
Therefore, social support protects mental and physical well-being from the direct and indirect effects of stress (Figure 13.19). For women, social support has been found in some studies to be a better predictor of life satisfaction, wellness, and achievement of health goals than behaviors such as exercising or abstaining from smoking (Denton et al., 2004; Moreno-Murcia et al., 2017). And although received social support gradually decreases during middle adulthood, middle-aged and older adults may not desire or need as much as when they were younger. In fact, “too much” perceived support may interfere with adults’ sense of mastery and contribute to them feeling useless or burdensome (Hill et al., 2023).
Participation in social activities is associated with better cognitive function (James et al., 2011), but differs by age and race. Even though younger and middle-aged adults spend more hours outside the home, older adults are five times more likely than their younger counterparts to participate in social clubs and organizations (most likely because they have more free time given reduced professional and caregiving responsibilities). Regardless, social integration (whether measured by hours outside the house or social activity participation) is predictive of global health throughout all stages of adulthood (Cherry et al., 2013). In fact, middle-aged adults may not need to go far to benefit from social engagement. Among both younger and middle-aged adults, positive exchanges with their spouse had a greater effect on lowering symptoms of depression than did positive social exchanges with other relatives and friends (Khan & Aftab, 2013; Okun & Keith, 1998).
Race is also a predictor of differences in types of social engagement and their effects on well-being . While Black and White adults over age fifty-five years report equivalent social network size and perceived social support, Black adults engage in less social activity than their White counterparts (Hamlin et al., 2022). 4 While lower social participation is not associated with decreased cognitive function for Black adults, perceived social support in middle adulthood predicts lowered depression and increased optimism for Black women (Seawell et al., 2014). 5 In response, researchers have suggested that communities examine possible barriers to the social participation of Black community members, including a lack of diversity in community activity organizers and culturally biased programming (Hamlin et al., 2022).
Stress Management
While middle adulthood might be one of the busiest times of life regarding what Erikson termed “generative” pursuits (such as caregiving, leadership, and mentoring), recent research suggests a certain amount of stress is both normative and potentially beneficial. In a study of adults aged twenty-five to seventy-five years, only 10 percent of participants reported no daily stress. Those adults were more likely to be older, unmarried, unemployed men. And while their apparently stress-free lives were associated with higher emotional well-being and fewer health problems, they also exhibited lower cognitive functioning and were less likely to give or receive emotional support. In other words, they were less likely to participate in and experience many of the benefits of midlife generativity (Charles et al., 2021).
So, how do adults make the most of the inherent stress of midlife? Crum and colleagues (2023) suggest considering the perspective of Shakespeare’s Hamlet: “For there is nothing either good or bad, but thinking makes it so.” In other words, your mindset about your life experiences shapes the effects those experiences have on you. Mindset refers to the assumptions and beliefs that guide our expectations and perceptions. To test this assertion, researchers trained employees of a Fortune 500 company to adopt a stress-as-enhancing mindset (Crum et al., 2017). The training included education about the benefits and risks of stress, the role of mindset in coping with stress, and strategies for controlling mindset to mitigate stress. At a one-month follow-up, these employees were more likely to perceive their stress as having potential benefits and to report better physical health and interpersonal interactions at work, compared to a control group. Lowered stress and increased well-being are also related to other health-connected behaviors such as diet, exercise, sleep, and even sexual activity (Dasgupta, 2018).
Diet and Nutrition
A healthy diet is linked to various beneficial health outcomes. As noted earlier, the Mediterranean diet focuses more on what a person eats than on exact portion sizes. Consisting of fruits, vegetables, nuts, healthy unsaturated fats (like olive or avocado oils), and lean meats (such as fish or poultry), this diet is associated with a decreased risk of CVD and premature death (Pant et al., 2023). In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), the Mediterranean diet, with the addition of vitamin D and reduced intake of sugar, salt, and alcohol, yielded increases in cognitive performance (Ngandu et al., 2015). Another study, Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND), found benefits to long-term memory (Morris et al., 2015). Eating a well-balanced and nutritious diet promotes cognitive and psychological well-being, in part because of the bidirectional connections between the nerves of the digestive system and the central nervous system, known as the gut-brain axis (Appleton, 2018). The nutrients listed in Table 13.1 have all been associated with a lower risk of poor mood and mood disorders (Dasgupta, 2018).
| Mood-Boosting Nutrients | Foods Where Found |
|---|---|
| Antioxidants | Coffee, dark chocolate, fruits and vegetables (such as potatoes and blueberries) |
| Folate | Dark leafy vegetables, fruit, beans |
| Vitamin B 12 | Poultry, fish, eggs, fortified cereals |
| Vitamin C | Citrus fruits, tomatoes, green and red peppers |
| Vitamin D | Tuna, fortified milk and cereals |
| Magnesium | Green leafy vegetables, nuts, whole grains |
| Selenium | Eggs, seafood, bread |
| Omega-3 fatty acid | Fish, canola oil, soy |
| Tryptophan | Nuts, turkey, whole grains |
To help people make these healthy choices, the National Heart, Lung, and Blood Institute (NHLBI) recommends reading the Nutrition Facts label on packaged foods and paying close attention to “% Daily Values.” Aim to consume more foods that have at least 20 percent of your daily recommended servings of potassium, fiber, vitamins C and A, calcium, and iron and eat fewer foods that contain more than 5 percent of your recommended servings of saturated and trans fats, cholesterol, and sodium (NHLBI, 2013).
Intersections and Contexts: Food Deserts
Access to healthy and nutritious foods is difficult for many. Over thirteen million people in the U.S. find themselves living in a low-access food area or “ food desert ,” where nutritious fresh foods are unaffordable and inaccessible (Johnson & Stewart, 2021). The lack of accessibility can be defined geographically as an urban area a mile or more from stores, or a rural area ten miles or more from stores, or it can be defined economically as an area with over 20 percent poverty. Researchers have also coined the related term “ food swamp ” to refer to areas where fast food and junk food are disproportionately available (Rose et al., 2009). Convenience stores that may have a closer proximity to many low-income areas largely sell highly processed foods, making it difficult for those with less access to transportation to acquire fruits, vegetables, and healthy proteins.
However, some residents living within areas with limited access to nutritious food are experimenting with ways to bridge this nutritional gap. Situated within a food desert, Syracuse University has started to offer a food pantry to students who need affordable access to nutritious food. Nearby Brady Farm runs a Community-Supported Agriculture (CSA) program using vacant urban land to offer locals weekly access to fresh-grown produce as well as education on how to cultivate and cook healthy foods (Hirst, 2023).
After learning that the county surrounding her campus contained fifteen food deserts, University of North Carolina Greensboro Professor Marianne LeGreco worked with community members to organize a farmers’ market to provide fresh food to local citizens. LeGreco notes the importance of being inclusive in such programs, such as accepting federal food benefit forms of payment. County officials also received a grant from the United Way to create a mobile produce market (named the Mobile Oasis) to reach residents in a wider area. In addition to food, the Mobile Oasis offers food education, including preparation tips, recipes, cooking utensils, and reusable shopping bags (Sykes, 2015; Institute for Community and Economic Engagement, 2012).
Exercise
Exercise is one of the most useful tools for promoting psychological health and well-being (Singh et al., 2023). What is the best type of exercise ? It’s difficult to say, because individuals have preferred activities and unique capabilities, plus habits formed in adolescence and early adulthood that continue later in life. The general recommendation is to get 150 minutes of moderately intense physical activity or 75 minutes of vigorous exercise each week (U.S. Department of Health and Human Services, 2018).
Walking can provide moderate-intensity exercise and can sometimes be accomplished during household chores (like vacuuming), workplace activities (like taking stairs rather the elevator), or childcare activities (such as moving around to soothe a fussy infant). In fact, walking is the most common form of moderate exercise for U.S. adults (Dasgupta, 2018). Weight-bearing and strength-training exercises are also important and are recommended twice a week. These are associated with stronger bone density to protect against osteoporosis and better muscle retention to guard against sarcopenia .
Exercise also has mental health benefits. Cardiovascular exercise, such as jogging, dancing, or swimming (also referred to as aerobic exercise or “cardio”), has been found to improve mood and reduce stress (Sharma et al., 2006). Yoga is also an effective way to manage stress and reduce resting heart rate, blood pressure, and stress hormones, such as cortisol (Ross & Thomas, 2010; Wang & Szabo, 2020). It can also improve balance and flexibility (Bhowmik Bhunia & Ray, 2024).
Sleep
Sleep is a critical part of health that is often sacrificed in favor of other obligations, such as work and family care (Basner et al., 2007). Sleep helps to consolidate new memories and flush toxins from the brain (Fulz et al., 2019; Klinzing et al., 2019). Inadequate sleep is associated with an increase in accidents and falls (Bloom et al., 2009), weight gain (Kobayashi et al., 2013; Patel et al., 2006), slower processing speed and memory (Kaur et al., 2019), increased risk of osteopenia and sarcopenia (Lucassen et al., 2017), and decreased immune health (AlDabal & BaHammam, 2011). It is recommended that middle-aged adults get at least six hours of high-quality sleep per night (Hirshkowitz et al., 2015). Sleep quality is the degree to which a person feels well rested after sleeping, which can be affected by how easily they fall asleep, stay asleep, and wake up, as well as the ease of their progression through sleep cycles, especially with respect to REM-stage sleep (Barnes et al., 2023).
Common middle-adulthood demands of work and family may require adults to get up earlier or go to bed later than desired or needed. They may also introduce stress-related restlessness and interruptions, which further reduce the quantity and quality of sleep. Sleep psychologists have identified a behavior termed “ revenge bedtime procrastination ,” in which individuals postpone sleep at the end of the day in favor of passive activities like watching television because their daytime schedule is too hectic to allow for any leisure or relaxation (Suni & Dimitriu, 2023). To protect against these impediments to sleep, the CDC recommends that adults try to adopt and maintain a consistent sleep schedule, create a comfortable sleeping environment free from distractions such as electronic devices, avoid large meals and stimulants before bedtime, and get regular physical exercise (CDC, 2024c).
Psychological Trauma and Resilience
While most midlife adults are coping with regular stressors, it may surprise you to learn that 70 percent report having experienced a traumatic event in their lifetime. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition , Text Revision (DSM-5-TR) defines a traumatic event as “exposure to actual or threatened death, serious injury, or sexual violence” (American Psychiatric Association, 2022).
The type of trauma and likelihood of occurrence vary by identity and environment. Women and girls are more likely to have experienced domestic and sexual violence, childhood abuse, life as a refugee, and the death of a child. Men are more apt to have survived or witnessed physical assault, disasters, and warfare (Benjet et al., 2016; Tolin & Foa, 2006). Worldwide data find that adults who are married and educated are less likely to be exposed to trauma (Benjet et al., 2016; Roberts et al., 2011).
Trauma responses vary in symptoms and severity, but they can include difficulty regulating emotions, attentional deficits, guilt, interpersonal difficulties, and even changes to areas of the brain that process emotion and memory, including the amygdala and hippocampus (Kunimatsu et al., 2020; Leite et al., 2022). Psychological and behavioral symptoms of trauma can affect not only the survivor but also others in their environment. Consequences of trauma can be both immediate and, if untreated, long term and intergenerational. Children of trauma survivors may be affected by the unhealthy behaviors or worldview of their caregivers, such as substance abuse or depression, and in some cases, those unhealthy behaviors and perspectives may be learned and repeated by the children themselves (Kuczyńska & Widera-Wysoczańska, 2010). Trauma can increase the risk of mental illnesses, including addiction, personality disorders, eating disorders, anxiety disorders, and mood disorders. Despite the high rates of experienced trauma, only 5 percent of U.S. adults are diagnosed with post-traumatic stress disorder. However, many adults do not seek treatment or receive a diagnosis, especially those from marginalized groups (Association for Behavioral and Cognitive Therapies, 2023).
Many adults find ways to adapt and overcome traumatic life experiences. A person’s resilience is their ability to successfully adapt to difficult life experiences by making mental, emotional, and behavioral adjustments to cope (American Psychological Association, 2018). What factors promote resilience and recovery after trauma? Much like the research on stress management, trauma research suggests that a person’s ability to return to healthy functioning relies on developing an adaptive mindset and receiving prompt social support, with each of these variables potentially affecting the other (Lin et al., 2022). Cultural and spiritual values provide a lens through which adults interpret and respond to trauma (Kalmanowitz & Ho, 2017). For many adults, their religious or ethnic identity can provide a framework for sustaining hope, finding a sense of belonging and meaning, and seeking out social support, all of which increase resilience among those reporting high affiliation with each of those identity aspects (Raghavan & Sandanapitchai, 2019; Veronese et al., 2017; Wexler, 2014). You can read more about the connection between well-being, hopefulness, and social support in Chapter 14 Social and Emotional Development in Middle Adulthood (Ages 30 to 59).
Link to Learning
The experiences of traumatic childhood events, such abuse, neglect, and domestic violence, are associated with an increased risk of adult health problems throughout the lifespan, including into the middle adulthood stage, when individuals are more likely to develop health risks and consequences such as cardiovascular disease, cancer, and depression. Watch this TED Talk by pediatrician Nadine Burke about the effects of childhood trauma to learn how exposure to adverse childhood events can be the catalyst of allostatic load across the lifetime when not addressed early.
Work-Life Balance
The average person will spend 90,000 hours working over their lifetime (Gettysburg College, n.d.). Work typically provides a source of income as well as a sense of purpose and identity, but employment is only one part of what individuals do. The concept of work-life balance describes the way people manage the demands of work, home life, and other interests, activities, and responsibilities. Lack of work-life balance can create burnout, which is associated with irritability, difficulty concentrating, fatigue, and increased risk of cardiovascular and mental illness (Arenofsky, 2017).
Successfully allocating limited resources of time, energy, and money is challenging, especially when inequalities related to gender and discrimination further complicate both work and family life. Parents in this stage of life may move out of the workforce and back to accommodate young children’s needs, and middle-aged adults may also need to fit the care of aging parents and family members in their schedules. During the pandemic, many employees of all ages had the opportunity, if not the mandate, to work from home for the first time. And amid all this change, for midlife workers, retirement drew nearer. All of these considerations are important in learning about the benefits and challenges of achieving a satisfying work-life balance in middle adulthood.
Wage Gaps and Paid Leave Policies
A persistent feature of work in the United States is the pay difference between men and women employees (Figure 13.20). Across full- and part-time workers, women earn only 82 percent of what similarly qualified men make, with the pay gap widening for those with higher education (Gould et al., 2016; Kochhar, 2023). In past decades, the divide has narrowed slightly, and pay equity is nearest for young adult women as they close gaps in educational attainment, experience, and occupational differences.
However, the gender pay gap increases with age, particularly when women reach the point at which many adults are balancing work responsibilities and childcare. Working women with children are more likely to work two fewer hours per week than their same-aged counterparts without children. On the other hand, working fathers work one additional hour per week, compared to men of the same age without children (Kochhar, 2023). These gender differences in the allocation of parenthood and working hours are called the “motherhood wage penalty” and the “fatherhood wage premium” (Glauber, 2018).
However, the pay gap in middle adulthood is not entirely attributable to the effect of balancing work and caregiving responsibilities. Pay disparities tend to inflate over time, because raises are often calculated as percentages of starting pay. The gender pay gap for entry-level positions is 18.4 percent (Haan & Reilly, 2024). Under those conditions, if a man begins working at a $50,000 salary, a similarly educated woman would, on average, be offered $40,800 to begin work at that same time. If one year later, each are given a 2 percent raise, the man’s raise would be $1,000, and the woman’s raise would be $408. One year later, their gender pay gap has already increased to 19 percent.
Paid leave work policies allow working adults to take time away to attend to their own health or their family members’ health or caregiving needs. This benefit could include medical leave to address a serious health condition, parental leave to care for a new child, caregiving leave to take care of a sick loved one, deployment-related leave to adjust to a family member’s military deployment, or safe leave to find safe refuge from sexual or domestic violence.
U.S. federal law does not guarantee paid leave under any of these circumstances, so access to paid leave is subject to the policies of the employer, and those with lower-income jobs and service-sector jobs are less likely to be afforded this benefit. Eleven U.S. states and territories have passed paid family and medical leave laws: California, Colorado, Connecticut, Delaware, Massachusetts, Maryland, New Jersey, New York, Oregon, Rhode Island, Washington state, and Washington, DC. These laws ensure cash benefits and sometimes job protection, health insurance, and protection from discrimination or retaliation because of medical, caregiving, or parental leave. However, the definition of “family” varies and does not necessarily include members of a person’s chosen family (Weston-Williamson, 2023).
Compared to other nations, the United States is alone in its limited access to paid leave. Data gathered on forty-one nations by the Organization for Economic Cooperation and Development found that the United States was the only country that did not federally protect paid parental leave, with most nations guaranteeing twenty weeks or more to parents with a new child (Figure 13.21). Topping the list was Estonia with eighty-six weeks of paid parental leave (Livingston & Thomas, 2019).
Workplaces and Schedules
Work-life balance and an individual’s sense of job satisfaction are impacted by many factors, including workplace location, commuting, and job schedules. With home internet access increasing (particularly in the wake of the COVID-19 pandemic), remote work has increasingly become an option in some careers. White-collar and technical jobs are more likely to be able to offer and support work-from-home positions, and U.S. workers with advanced degrees are more likely to work from home full or part time (Haan & Main, 2023). Women, older adults, and those with lower education or income are less likely to be afforded work-from-home or flexible schedule options (Dua et al., 2022).
Almost 13 percent of full-time employees work from home, and another 28 percent follow a hybrid model that combines in-office and work-from-home time. These arrangements have yielded a mix of results and individual preferences. Working from home can reduce the time, stress, and cost of commuting, and workers with jobs that require greater amounts of individual concentration seem to benefit from the opportunity to reduce workplace interruptions by working outside the office (Golden & Gajendran, 2019). Employees also say that working from home allows for greater flexibility in how they spend their time and even flexibility in where they choose to live (Buffer, 2023).
But not all workers have this experience. While employee surveys have also found that remote work corresponds with reduced stress for some (42 percent), there are also drawbacks. Some employees find that working from home is isolating and reduces collaboration and the chance to build relationships with coworkers. Others report that with the lines blurred between home and office, they end up working longer hours. Also, only one-third of employees working from home have a dedicated office space at home—the rest work from their bedroom, living room, or even move from room to room throughout the day (Figure 13.22). Despite the drawbacks, however, 98 percent of those who currently work remotely would prefer to continue to do so, at least part of the time, for the rest of their career (Allen et al., 2015; Done, 2022).
Some workplaces have experimented with transitioning from a traditional five-day workweek to a four-day week. In 2022, more than sixty companies and almost 3,000 workers in the United Kingdom participated for six months in an experiment with the four-day work week (Lewis et al., 2023). Findings from the study showed that the shortened schedule resulted in lower rates of employee stress and burnout, and more than half of employees reported improvements in options around work-life balance. Of the participating businesses, 92 percent planned to continue the four-days-a-week model. This model not only can provide more flexibility in the work week but also cuts down on commuting time.
The average commute to work in the United States is nearly thirty minutes each way, with most leaving between 6 and 8:30 a.m., which makes it particularly difficult to get school-aged kids off to school. The longest commutes are for those using public transportation (U.S. Census Bureau, 2021). Adjusting to a four-days-a-week model saves one hour of time (that could be allocated to work, caregiving, or leisure), reduces rush-hour congestion on public transportation and roads, saves fuel costs, and thereby may allow more opportunity to balance responsibilities at work and home.
Job Satisfaction
Job satisfaction generally increases with age and is predicted by factors such as perceived support at work, level of job engagement, and opportunities for planning and control over work tasks, but satisfaction is not increased by time spent working in a single organization (Indryawati et al., 2022; Safitri et al., 2020). Rather, across a wide variety of occupations, increased job satisfaction over the lifespan is better accounted for by increases in pay or position that result from moving from one workplace to another, rather than remaining in a single organization (Riza et al. 2016). In fact, job satisfaction is negatively correlated to the amount of time spent working for the same organization. Inflexible job hours, job insecurity, perceived lack of control over daily work, poor relationships with coworkers, discrimination in the workplace, and work stress all predict increased feelings of work dissatisfaction (Stats, 2019). Chronic dissatisfaction can lead to burnout , a state in which long-term job-related stress leads to disillusionment and lack of energy.
Perhaps for reasons like these, there has been a substantial rise in the number of workers who are self-employed, particularly among women, Black and Hispanic adults, and those with young children. Self-employment can offer greater autonomy in the organization of work and is most common in the fields of transportation, communication, personal services (which can include anything from accounting to health care), and recreational services (such as entertainment) (Cai & Baker, 2023). 6
The careers of many adults reach their peak in midlife, when they often produce high-quality, creative work. However, career adjustments and changes in work arrangements have grown more frequent in recent years. Since the start of the COVID-19 pandemic, for example, more than 20 percent of adults over age forty years have changed not just their jobs but their careers (Prudential, 2021). Another 46 percent considered or are considering a change, even if doing so means taking a reduction in pay (Microsoft, 2021). Some individuals change jobs and careers by choice, seeking more fulfilling employment or attempting to change a situation of stagnation or burnout. Those seeking new work because of dissatisfaction may find the contentment of a new job fleeting after the newness wears off and then reengage in the job search cycle (Riza et al., 2016). At other times, job changes are involuntary and result from changes in a company or industry, such as layoffs, mergers, relocations, or even closures. These uncontrollable events tend to be more psychologically taxing on employees (Crowley et al., 2003).
The stress of unexpected unemployment can be minimized by support, encouragement, and understanding from significant others (Vinokur & van Ryn, 1993) (Figure 13.23). Individuals in these circumstances also benefit from the use of problem-focused coping skills (oriented toward problem-solving) and emotion-focused coping skills (oriented toward managing stress and other distressing feelings) (Cook & Heppner, 1997; Tsaur et al., 2015).
Outside of one’s job, engaging in interests and leisure activities is an important element of work-life balance. Adults between the ages of twenty-five and sixty years report having a daily average of five hours of free time, with men reporting approximately thirty more minutes of free time per day than women. More than half of that free time is spent in front of a screen (cell phone, computer, TV) (Sturm & Cohen, 2019).
Due to caregiving and work responsibilities, midlife adults spend very little time in physical leisure activities (daily average of twenty minutes for men and daily average of thirteen minutes for women), though overall available free time and physical leisure activities increase on the weekends (U.S. Bureau of Labor Statistics, 2023; Sturm & Cohen, 2019). Physical activities performed during leisure time, like hiking, walking, biking, running, and dancing, are associated with increased lifespans (Schnohr et al., 2017). Those adults who engaged in high levels of physical activity saw the greatest lifespan benefit of 5.5 years; those engaging in moderate levels benefited by 4.5 years. Even light activity can add 2.8 years to the lifespan. Cognitive abilities are also improved by leisure activities. Researchers have found less cognitive decline when leisure time includes games, puzzles, or physical activities (Andel et al., 2016). Improving work-life balance by engaging in personal leisure activities provides adults with several health benefits, including lowered stress levels (du Prel et al., 2019) and reduced likelihood of burnout (Wolff et al., 2021), outcomes that are important to overall well-being.
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Footnotes
- 3 This study (Badr et al., 2018) uses the term "Western" for "Lebanese-American" participants and uses "Middle Eastern" for "Lebanese" participants in Lebanon.
- 4 This study (Hamlin et al., 2022) uses the terms "non-Hispanic White" and "non-Hispanic Black."
- 5 This study (Seawell et al., 2014) uses the term "African American."
- 6 This study (Cai & Baker, 2023) uses the terms "Black," "White," "Hispanic," and "Other."