Middle age is the period of full human growth and development defined as the age 40-60. The age of forty is the age of guidance. By the age of 40 a person's character and personality have stabilized. The age of 60 is the start of old age. It represents the completion of growth and development.

CHARACTERISTICS OF THE MIDDLE AGES

Middle age is characterized by wisdom, actualization, balance, caution, and completion of family and career. It is the stage of complete wisdom and moral rectitude. Actualization is a stage of feeling of fulfillment. There is balance between intellect and wisdom; balance between impulse and caution; and balance between conservation or maintenance and innovation. By middle age there is a more cautious approach to life. Risks and reactions are weighed carefully before taking any drastic action. Because of physical and intellectual decline after middle age, no new major achievements or break-throughs are expected. The end of middle age completes the family. For most people there are no more new children to look after. The older children are themselves becoming adults and setting up their own families.

BIOLOGICAL ASPECTS

Biological decline is progressive. Each person and each organ declines at a different rate. Tissue growth declines until the equilibrium between growth/repair and degeneration is tipped in favor of degeneration. Immunological response declines making the elderly more prone to infectious and neoplastic diseases. Sensory organs decline gradually decreasing the impact of environmental stimulation. Male testicular function declines but there is no male climacteric. Sexual difficulties are due to the associated diseases. In female menopause the ovary is not responsive to gonadotrophins so that the menstrual cycles disappear. Menopause like adolescence has many biological and psychological problems because it is a period of transition. The post-menopausal syndrome consists of the physical symptoms of hot flushes as well as psychic changes. There is general decline in cognition and memory. The speed of intellectual processing is slower than in the youths. The incipient intellectual decline may not be easily noticed because of the compensatory effect of the accumulated wisdom and experience of middle age. Memory decline is more serious for short than long-term memory. Long-term memory is remarkably well preserved.

PSYCHOLOGICAL ASPECTS

Psychological balance predominates towards the end of middle age. There is psychological and emotional stability as a result of a conscious renunciation of the pursuit of material achievements. The middle aged has realized that there are things in life that will never be achieved. He also has learned to accept and live with his limitations and failures. He has the balanced view of the world in which he appreciates the successes and does not lose sleep over failures. Apart from depression that is common the middle aged does not suffer from major psychological or emotional crises. He is able to cope with the social or psychological stresses that he meets. The mid-life crisis is a major and drastic change in personality and behavior in a few people. It is more due to psychological than physical factors. The mid-life crisis is due to the realization that many of the youthful ambitions will never be fulfilled. In a few persons it manifests as a return to more youthful behavior like promiscuity and seeking youthful entertainment. It also may manifest as an attempt to deny the onset of middle age. In females the mid-life crisis is intertwined with the onset of the climacteric. There are behavioral changes mediated by hormonal changes. There are also behavioral changes due to fear of old age and loss of sexual attractiveness.

SOCIAL ASPECTS

Late middle age is the last stage of family rearing. By this time children are either adolescents or are young adults. There are still youth problems that the middle-aged parent may have to cope with. Late middle age is also a time of transfer of leadership to the new generation. The middle-aged parents must train their offspring and give them increasing responsibilities so that a smooth transition can be achieved without the problem of a ‘generation gap’