Midlife is a tipping point for many Kiwis but the changes in health and wellbeing are poorly understood. What can help the sandwich generation live long and prosper?
Elaine Atkinson had it all: a home in a flash suburb of Auckland and a high-flying corporate job at Fisher & Paykel. It had been an uphill struggle to get to that point but life as a single mother, a couple of broken relationships and a life-threatening addiction hadn’t stopped her from building a life that afforded her recognition and comfort by her early 50s.
Atkinson should have been fulfilled but she wasn’t. In long-term recovery for alcohol addiction, she had been volunteering at a rehabilitation centre and dreamed of opening her own. “I loved helping and seeing people make changes in their life. They would come into rehab fragile and unwell and they’d go home looking extremely well and ready to start their new life. It brought me great joy.”
She’d written a business plan but it sat in a drawer for five years. Meanwhile, changes in her job made her uneasy. “Management was changing and the corporate world was moving so fast. I didn’t know whether I wanted to keep up with it.”
Those shifts coincided with meeting a new partner who lived in Hawke’s Bay. After a few months of commuting to keep the long-distance romance alive, she decided it was time for a change.
“One day, I was sitting at work and got that business plan out. I decided I would move to Hawke’s Bay. It was a turning point for me.”
Atkinson cashed in her superannuation and mortgaged her house to get the business – Ocean Hills – going. “My family thought I was a bit crazy, giving up a big salary and life in Auckland. And I was nervous – my job was my identity.
“But really, it was my big fat ego and I felt it was my time in life to be really brave.”
Five years on, the business – Hawke’s Bay’s only private drug and alcohol treatment centre – is thriving. “It’s had its scary moments and it was a lot harder than I ever imagined, but I’ve loved every minute of it.”
Several of her clients have recently celebrated four years sober. “It’s been a wonderful journey watching my dream become such an amazing reality.”
Best & worst of times
It isn’t a coincidence that Atkinson made this change in her 50s. This age and stage used to be blamed for the midlife crisis, the time of life when an otherwise sane and reasonable person suddenly changes partners, quits their job, gets plastic surgery or buys a red sports car.
Just how pervasive the midlife crisis is is a subject of much academic debate. A 2020 study published in American Psychologist, the journal of the American Psychological Association, says only about 10-20% of us experience the traditional (or mythical) full-blown crisis.
But the “Midlife in the 2020s: Opportunities and Challenges” study points out that today’s middle-aged adults are facing unprecedented challenges, including “changes in relationships with their aging parents, adult children and grandchildren as well as vulnerabilities that emerge from economic failures, labour market volatility and a shrinking social and healthcare safety net”.
Generation X has now come of age – middle age, that is – and their midlives are shaping up to be as unique as their wild, unsupervised latch-key childhoods were. The youngest Xers are aged 44 and the oldest 59. They make up nearly 20% of New Zealand’s population, are the highest earners and carry the biggest economic burdens. They’re dubbed the “sandwich generation” because of the circumstances identified in the “Midlife” study – often supporting children well into adulthood and looking after ageing parents.
It’s also apparent that, with people generally living longer, many will have to work well past 65 to support themselves, state pension and KiwiSaver savings notwithstanding. It’s more work than any modern generation has ever carried. Wallets aside, the question that needs answering is: will their health measure up to this?
Midlife knowledge gap
The US study points out that strikingly little is known about midlife health and development; it’s largely uncharted territory for research. Moana Theodore (Ngāpuhi), director of the Dunedin Study –New Zealand’s famous longitudinal study of the health, development and wellbeing that charts 1037 New Zealanders – agrees midlife is a poorly researched area. But that’s about to change.
Charting changes
Midlife is often not considered to be a time of great change, says Theodore. “However, a lot happens to us during our 30s, 40s and 50s, not only in terms of major life events, but also changes in our health, including how we age, as our study has found.
“Developmentally, studies have focused on changes in childhood and adolescence, and then in older age groups. However, there has been less research undertaken where people are followed over time, as we do in these longitudinal studies, throughout midlife to see what happens to them in terms of their health and lives.”
The Dunedin Study started in 1972, so the current phase of the study is called the “52 assessments”. The question researchers are asking is, “How are we ageing?”
It’s the 10th time study members have been assessed; the last phase was in 2017-19, when they were aged about 45. With many now scattered around New Zealand, Australia and other parts of the globe, the members are now returning to Dunedin for 11/2 days of assessments.
For a lot of Gen X people, their biological age is probably younger than their actual age.
Using the DunedinPACE (Pace of Aging Calculated from the Epigenome) algorithm now implemented in many global studies, researchers will use 19 biomarkers to measure the members’ physical health. The tool is a bit like a speedometer, with an average rate of one biological year for each chronological year (read more about it here).
Famously, the method was recently used on Kim Kardashian. Aged 43 at the time, she had an ageing pace of 0.82, meaning she was ageing 18% slower than most people of her age. Her sister Khloe, then 39, was ageing at an impressive 28% lower than the average person her age.
In about two years, this research will provide a clearer picture of how Gen Xers are tracking through their 50s. The data produced is crucial to informing government policies around health and ageing, Theodore says. “This study is about what can be done to support people to live healthier lives for longer, and now, people are starting to talk about this life-course approach [a plan to manage healthy ageing],” she says.
An “unashamed Gen Xer” herself, she became involved in the Dunedin Study as a 23-year-old researcher in 1998. She finds 52 to be particularly interesting because of the life changes happening around this age.
“People’s children are older, and they might be moving into grandparenting. We know that some of our study members are already grandparents. A number of them might be helping parents who are now in old age. So, we’ll be asking about their attitudes toward ageing.”
Living longer
One thing we know for sure is that midlife is expanding because we live longer. Current life expectancy for New Zealand women is 83.5 years and 80 for men, but those figures change according to your current age. For example, Stats NZ’s “How long will I live?” calculator shows the average life expectancy of a woman now aged 53 ranges from 87.1 to 89.6 years.
Paul Spoonley, sociologist and emeritus professor at Massey University, says New Zealanders are adding about two years of life expectancy per decade. For every generation since the early 20th century, life expectancy has risen due to factors such as better medical care, improved nutrition and lifestyle factors such as not smoking, he says.
“The Baby Boomers have been a major beneficiary of these developments, combined with the fact they have accumulated wealth from property ownership and the gifts of the welfare state. Gen X also share in some of these health and life expectancy benefits but are less likely to be as wealthy as Baby Boomers.”
Comparing Xers to the Boomers across lifespan and finances is one thing, but finding out how they measure up healthwise is trickier because of the lack of comparative studies, according to Ross Lawrenson, a professor of population health at the University of Waikato.
Despite the lack of data, he estimates many Gen Xers are healthier in midlife than the Boomers were. Social gradients help to dictate health outcomes, which is a good thing for Gen Xers who are known as a “managerial class”, he says.
Since fewer are toiling away in physical jobs, they’ll have fewer wear-and-tear issues such as arthritis, he says. The more privileged among us eat better, smoke less and have more access to health services and information than any other generation.
“I think for a lot of Gen X people, their biological age is probably younger than their actual age.”
Ageing peaks
Scientists from Stanford University in California recently pinpointed physical ageing “bursts” in people at the ages of 44 and 60. The 44-year-olds showed a drop in ability to metabolise alcohol, caffeine and lipids, as well as dramatic changes in skin and muscle proteins, says geneticist and senior study author Professor Michael Snyder. He says rising lipid levels are associated long term with diseases such as heart disease and stroke. As for alcohol, “In general, people in their 40s see changes in alcohol metabolism. They might take one less drink to enjoy themselves.”
Though the study was focused on health, Snyder says his research team have essentially ended up tracking ageing. In 2020, they pinpointed ageotypes, which measure how people age according to their metabolic, immuno, hepatic (liver) and nephrotic (kidney) pathways.
Snyder says researchers weren’t surprised when people over 60 in the study found their health had declined – at that age, they had a sharp drop in carbohydrate metabolism and kidney function, which may lift the risk of diabetes.
The changes they identified at age 44 could be about people becoming more sedentary and not eating as well, or a poor lifestyle catching up with them, says Snyder.
It’s not too late to make changes for healthier ageing, although it’s not as simple as just eating well and exercising more, he says. He recommends starting statin treatment for high cholesterol levels earlier rather than later and eating foods high in antioxidants and polyphenols, such as blueberries and olives.
Preserving muscle mass as you age is a “big, big deal” and starting a weight-training programme in your 40s is essential, he says. Sarcopenia, loss of muscle mass, affects people as they hit their 60s and has a dramatic effect on mobility. If mobility plummets, health plummets.
“I’m a big believer in strength training versus aerobic endurance training.”
Snyder, who co-founded metabolic profiling lab iollo, says metabolic profiling is increasingly useful for personalising medicine and can even point to types of food that suit you.
Hormone therapy is another way Gen X women are putting their stamp on midlife. The first generation to have relatively open access to hormone replacement therapy (HRT), which not only treats the symptoms of perimenopause but can significantly improve health beyond menopause, says Dr Deborah Brunt, a specialist GP in women’s health in Ōtepoti Dunedin.
Being on HRT has important impacts for bone health and metabolic health, Brunt says. Problems with metabolic health can lead to diabetes and heart disease and bone issues can lead to fractures.
“These are two of the main issues we face in ageing. There’s definitely some good evidence to show that HRT is beneficial in pushing those diseases further out into your lifespan.”
Hormone therapy can also go some way to challenging the notion that women are “over the hill” once they hit menopause, she says.
“I think we have a huge lot of cultural conditioning to change. Gen X women will have longer lifespans, and we are working to push our health spans out longer.”
Psychologically, the period of midlife is a challenge and Gen Xers are juggling more than their parents ever did with demanding careers, responsibilities for children and ageing parents, says Auckland-based clinical psychologist and neuropsychologist Louise Cowpertwait.
“These days, people are still nurturing their children and teenagers until they’re into their early adulthood,” Cowpertwait says. “Right into the early 20s, parents are still providing a lot of support.”
Our midlife is also being delayed, as we have children later. “We can have a midlife that didn’t really exist before.”
With so much going on at this age, midlifers could be forgiven for falling into an identity crisis, but Cowpertwait prefers to term this period a turning point where decisions have to be made. “I like the idea of myth-busting the midlife crisis narratives, like thinking about all the things we gain rather than what we lose.”
Most people, if they’re paying attention, will notice that once they get out in nature, they relax a lot more.
Swiss psychiatrist and psychotherapist Carl Jung said, “The first half of life is devoted to forming a healthy ego, the second half is going inward and letting go of it.”
“He talked a lot about midlife transition,” says Auckland clinical psychologist Lea Holford. “That initial stage is about getting security, assets, an education, raising families and getting a partner.”
At the midlife juncture, Jung said we make a pivot, essentially to find the meaning of life. At this point, people can find themselves exhausted and, despite achievements, feel discontent.
“They are feeling kind of burnt out and, like, ‘Is this all there is after all that I’ve gone through, how hard I’ve worked, all these achievements?’”
When things haven’t worked out the way we want, our ego can take a tumble, which is a good thing if we’re interested in living a liberated life, Holford says.
She points to American transpersonal psychology theorist Michael Washburn’s take: “He said at this point, you have three choices. You redouble the efforts of the ego, you have a health collapse, or you become spiritual.”
Eyes open
According to Washburn, emeritus professor of philosophy at Indiana University-South Bend, middle age is the time we become “embodied” (more aware of our bodies) and this can lead to activities such as yoga, tai chi, gardening, being in nature and anything that leads to repose and contemplation.
Holford says, “Most people, if they’re paying attention, will notice that once they get out in nature, they relax a lot more.
“They start breathing properly. If they’re exercising, they will notice that they can feel everything. Their sensory mechanisms really pick up a lot.”
It’s also the platform to make sense of the next part of our lives, she adds.
Mining for jewels in disillusionment is not straightforward, though. It helps to have the privileges of education, resources and a reasonable baseline of wellbeing.
“If you have an emotional/mental illness, you need to heal from that. But if you’re reasonably healthy, the hemispheres do start to balance out more and people learn to live with ambiguity better,” Holford says.
When attachment to achievement and control is dropped, love for family and friends and a reverence for life itself can go a long way to answering questions about the meaning of life.
That certainly seems to have been the case for Elaine Atkinson with her career switch and move to Hawke’s Bay. “I don’t think it was a midlife crisis. At 54, I knew I only had so many years of working ahead of me and I wanted to do something with my life that was fulfilling. And I’d had enough of being in corporate.
“I have absolutely no regrets. The best thing I ever did was to be brave enough to leave my comfortable salary.”
