All is not lost on the middle aged person (age 41 – 60). Middle aged people tend to be more conservative in their approaches to life, often approaching life’s problems as challenges as opposed to threats. Middle aged people sometimes struggle with the passage of their own children into adulthood. This lack of familial interaction leads to empty nest syndrome (the feeling of grief from the vacuum created by their children moving on). The vast majority of middle aged people struggle with financial commitments either on behalf of their parents or their children.

Most of the original equipment is functioning at a high level during these years, however it is obvious that the peak years are over. During these years, vision and hearing becomes less effective. Cardiovascular health often becomes a concern as cardiac output decreases while cholesterol levels increase, leading to increased peripheral vascular resistance. Cancer strikes this age group and weight control is always more difficult due to decreasing metabolism. Women experience menopause in their 40’s and 50’s. The lack of consistent flow of estrogen causes lots of problems for women the same way that flow of testosterone causes lots of problems for men.

As the middle aged adult reaches late adulthood (age 61 and older), they sometimes maintain good health and even have normal vital signs. Other late adults history of poor health in earlier years catch up with them. Hypertension, diabetes, and cardiac arrhythmias seem to be the most common. In many cultures, the late adult is celebrated and embraced as one possessing wisdom not found in other age groups (not so much in the western world). The elderly constantly battle with a sense of decreased self worth, declining well being, and financial burden. Many of their friends and family are dead. The elderly experience tremendous loneliness.

The respiratory system of the late adult sees it’s share of changes as well. The muscles of the chest wall weaken. Lung capacity is diminished leading to less gas exchange in the alveoli. The tissues in the larynx may stiffen, affecting the pitch and quality of the voice and causing hoarseness. Changes in the tissues of the throat (pharynx) may lead to the leakage of food or fluids into the trachea during swallowing (aspiration). If persistent or severe, aspiration may cause pneumonia. There is also evidence that at the cellular level, the muscles of elderly individuals have less mitochondrial adenosine triphosphate reserves to sustain a sudden increase in metabolic demand.  If an elderly person becomes ill with pneumonia, and therefore has increased metabolic demands for oxygen in the setting of decreased respiratory muscle strength, decreased cellular energy reserve, and decreased overall muscle function, he or she may not be able to meet those demands. This leads to an increased risk of respiratory failure in older individuals. The elasticity of the diaphragm is diminished and the chest wall weakens. The ability to facilitate diffusion of oxygen and CO2 is decreased leading to decreased blood oxygen saturation levels. This age group sees decreased lung capacity. Coughing becomes less effective due to weakened chest walls and bone structure.

It is usually expected that the late adult has at least some measure of hypertension as their efficiency of their circulatory system system decreases. Their functional blood volume decreases which makes them less capable of tolerating tachycardias. The cardiovascular system experiences changes that lead to decreased function. The blood vessels thicken and lead to increased peripheral vascular resistance. This increased peripheral vascular resistance leads to reduced blood flow to organs. With all the increased resistance, the heart experiences increased workload. The myocardium is less able to respond to exercise.

Late adults experience a range of gastrointestinal, renal, and endocrine changes. Decreased insulin production leads to decreased glucose metabolism. Exocrine secretions in the mouth, lungs, gastrointestinal tract result in dried skin, mucous membranes, and mouth. The decreased gastrointestinal secretions lead to vitamin and mineral deficiencies. A large numbers of working nephrons (functional unit of the kidney) are lost to age. The decreased number of working nephrons lead to glomeruli abnormalities. Glomeruli are blood vessels that act as strainers, removing waste and water from the blood and sending them to the nephrons to be processed as urine. The result is decreased elimination of urine.

The neurological deterioration of the late adult is widespread and profound. Late adults also experience a loss of taste buds and decreased olfactory function. Decreased pain perception and diminished ability to move. Visual acuity and reaction time are diminished (making driving very dangerous). One would think that hearing loss would ensure sound sleep, however late adults experience sleep-wake cycle disruptions more than younger age groups.

The maximum life span for a human is considered 120 years. Life expectancy conveys the average length of life based on year of birth and varies based on region of the world.