One of the advantages of reaching midlife is that we are finally finished with all those issues that make childhood and adolescence such a pain in the neck, such as needing set bedtimes as well as regular dental and eye checkups; having to worry about using protection during sex and about cigarette smoking; getting all those shots to prevent diseases and wearing helmets to prevent sports injuries; needing to eat all our vegetables and avoid sugar as well as not missing gym class. What a relief to let these issues fade right along with our memories of tetherball on the school playground!

Not so fast. Would it surprise you to know that you still have to be aware of each and every one of the above so-called "child/adolescent" health issues?

For instance, what about set bedtimes? The obvious reason that we needed enforced, regular  bedtimes each night was so that we would get enough sleep. Being tired and sleepy the next day in school caused everything from lousy concentration to crabby moods. Now that we're in midlife, many of us believe that sleep is no longer an issue. This is not the case at all. It's still essential to our health and wellbeing. Recent studies have shown that not only do sleep disturbances often indicate a serious health problem, but that lack of sleep can actually cause health problems, such as weight gain. Polls have shown that nearly two thirds of adults over the age of sixty-five have sleep complaints, but that less than 15 per cent of them have been formally diagnosed with a sleep problem. Why? Because we don't mention sleep problems to our health care providers. Our mothers were right -- we still need to be concerned about our bedtimes.

Once we've gotten the glasses we need and all our baby teeth are gone, we no longer need to get regular eye and dental checkups as we did in our younger years, right? Again -- no. Although our vision does remain stable from young adulthood until we need bifocals, there are common eye diseases that begin to occur in midlife, and that can lead to blindness if not diagnosed.  And even though we no longer have our baby teeth,  other dental issues take the forefront upon reaching midlife, such as gum inflammation which has been shown to be associated with diabetes and heart disease. So, continued regular dental and eye checks are as important as in our younger years.

And what about sex at midlife and beyond?  We've moved from groping and being groped in the backseat of the car to more sophisticated maneuvers in a comfortable bed, and finally, finally no longer have to worry about pregnancy. So we don't need protection; or so many of us think. Although it's true that once menopause arrives one can't get pregnant (warning: make sure you have completed menopause before assuming this as diagnosing menopause can be tricky),  protection is still needed during sex because of sexually transmitted infections (STIs). Yes, we can still get those, and in some cases are even more prone to becoming infected after menopause, even after a hysterectomy. And even though we're past the childbearing years and our reproductive organs seem to have no further use, we still need regular pelvic exams and Pap smears. It is also important at that exam to discuss with our healthcare providers the need for testing for STIs; if there is a new partner or the worry that the current partner is not monogamous, this testing is a must.

STIs are not the only threat held over from our adolescent years; so is cigarette smoking. Many women in midlife think that there is no reason to stop smoking cigarettes at this age, since they wrongly assume that the damage is already done from all the prior years of smoking. This is not the case. No matter how many years one has smoked, stopping can prevent further damage to the heart, blood vessels, and lungs, and in some cases can reverse some of that damage.

Also relevant to the lungs is the fact that asthma can begin in midlife, where once it was thought to only begin in childhood.  The two major causes seem to be occupational exposure to substances that damage the lungs, and the recreational exposure to air pollution by adults who run predominantly outside. So, a new onset of shortness of breath at this age -- even if it occurs only with exercise -- does not necessarily mean heart disease; remember that we can develop asthma now.

Did you think you were finished with all those horrible shots you had to have in childhood and adolescence? Sorry, you're not. There is a recommended immunization schedule for adults in midlife and beyond, just as there are for children. At certain ages over 50 and at certain intervals, you'll need shots against the flu, certain types of pneumonia, tetanus, and in some instances, shingles and hepatitis.  Ask your primary care provider about these.

And did you pack away your helmet when you gave away your bike with training wheels? Probably ok to have done this since now you will need a bigger size helmet. But you do need a helmet. A recent report by the U.S. Consumer Product Safety Commission stated that sports-related injuries in the Baby Boomer population was on the rise, with over 1 million injuries in this age group in 1998 alone, most of the injuries being due to bicycling and basketball.  The same report said that the many head injuries associated with bicycling were probably due to the fact that Baby Boomers use helmets less than younger people do.

The fact that exercise and proper nutrition are as important in midlife and beyond as in childhood may not come as a surprise. Regular exercise at this age has been shown to increase longevity and wellbeing, postpone and possibly prevent dementia, strokes, heart disease, and diabetes, and aid in the treatment of depression. Important to know as well is that several different types of regular exercise are recommended at this age, including aerobic (cardio) exercise, weight-bearing exercise or strength training, and exercises to improve balance and flexibility.

What we eat as we get older is every bit as important as it was in our younger years. One particular healthy way of eating, the Mediterranean diet, has been shown to stave off dementia, prevent heart disease and diabetes, maintain a healthy cholesterol level, and improve longevity. One study showed that this diet even improved sexual function in certain women! This diet is exactly as expected given its name: lots of natural whole foods, like vegetables, fruits, and nuts, lots of fish and olive oil, moderate amounts of wine, and limited amounts of foods containing refined sugar. Controlling the portions of the foods we eat is even more important at this age. Our metabolic rate decreases with age, making it easier to gain weight while eating the same amounts of food as in our younger years.

So, as you are rummaging through your mother's attic looking at your old dolls, baseball bat and Ouija Board, and breathing a sigh of relief that you no longer have to worry about being picked for a baseball team or that your best friend copied your paper doll's dress, don’t get lulled into complacency about your health. Although you once may have thought that taking care of yourself  health-wise would get easier as you get older, you know now that that's not true. Make your appointments for regular checkups, get more than 5 hours of sleep a night, use protection when having sex, particularly with a new partner, stop smoking no matter how old you are, get the recommended immunizations, be careful and wear your helmet and seatbelts, and exercise regularly and eat well. Your mother’s recommendations from your childhood continue to apply!

©2008 Janet Horn, M.D. and Robin H. Miller, M.D.