As we are abundantly aware, our society routinely associates sex with youth, beauty, wellness, and vitality. Recent research findings as well as the common experiences of long-term care and assisted living providers make a compelling case for making sexual health and wellness part of overall resident care. To do this, we must correct the myths surrounding sex and seniors, educate staff and frontline caregivers, and implement strategies at the community level to create a comfortable environment that nurtures expressions of intimacy, sexual health, and wellness.
I recently lost my beloved father, who had complex medical conditions and died of terminal malignant melanoma. He was 85 years old and was married to my mother for almost 60 years. They remained deeply in love and, until shortly before his death, regularly enjoyed an intimate and sexual relationship.
I have been a clinician for many years, but firmly believe the intimacy and sexuality my parents shared gave my father great emotional comfort and periodic relief from his disease processes and the associated pain and suffering during the last years of his life. He was on home hospice and my mother was cradling him in her arms when he took his last breath. They were physically and emotionally connected to the end.
Grandma and Grandpa do what?
In most Western cultures, discussing personal sexual behavior and practices can be uncomfortable at best. When turning the focus to discuss sexual relations among older adults, reactions can range from uncomfortable to horrified. Many people would rather not talk or think about their own parents or grandparents engaging in sexual acts and, consequently, the topic of sex among seniors is often dismissed as a nonissue, a joke, or a conversation that many would rather avoid altogether.
Love, sex, and intimacy are ageless and can have many health and psychosocial benefits in our senior years. I believe that intimacy and a meaningful sexual relationship at any age involve a great deal more than the act of sexual intercourse. Seniors often “get this” and have improved intimacy and sexual relations as they reach their later years. For many seniors, a great deal of intimacy and emotional satisfaction can be derived from touching, kissing, embracing, sensual massage, or simply holding hands.
Research has demonstrated that individuals who have enjoyed an active and healthy sex life throughout adulthood are likely to continue doing so well into their later years. It is important that caregivers understand that a “sexuality light switch” is not flipped off when we turn 70 or 80 years of age. Although sexual expression and fulfillment may not involve penetration, a substantial number of seniors still engage in intercourse, oral sex, and self-stimulation even into the eighth and ninth decades of life.
According to Dr. Patricia Bloom, associate professor of geriatrics and palliative medicine at The Mount Sinai Medical Center in New York City, “The level of sexual interest and activity among people over 65 is as diverse as the individuals who make up that population.” Many older adults actually report that their sex lives improve as they age. There is no longer a fear of pregnancy or of children interrupting the sexual encounter. Sexuality remains a basic human need and sexual relationships have occurred and will continue to occur between residents in our communities.
Barriers to sexual expression
A New England Journal of Medicine study conducted in 2007 revealed that only 22% of women and 38% of men had discussed sex with a doctor since age 50. Given these statistics, physician communication may be poor, and many are uncomfortable broaching the topic of sexuality with their elderly patients. Nurses or social workers, who have established relationships with residents, may be in a better position to discuss sexual health issues, and then refer them to a physician as necessary or requested. It should be noted that many residents may be uncomfortable discussing sexual problems with caregivers because of guilt, shame, misinformation, or sexual dysfunction. Conversations should be conducted in private and with the utmost sensitivity to the residents' identified concerns and issues.
Among the sexually active participants in the NEJM study, half reported at least one bothersome sexual problem, with many avoiding sexual activity as a result. In addition, negative attitudes still prevail about women's sexuality and sex at older ages. This is very alarming in that many of the problems with sexual function in the later years are often associated with underlying physiologic problems resulting from disease processes. Research clearly indicates that both men and women in poor health are less likely to be sexually active in their later years. Clearly, many older adults could benefit from discussions and therapeutic interventions targeting sexual health.
Impact of history and medical conditions
Unlike older adults who have enjoyed healthy sexual expression in their younger years, an older adult whose sexual experiences have been linked to physical or psychological pain, rejection, humiliation, and guilt will likely continue to avoid sexual contact and intimacy as a senior. Although many individuals enjoy full and loving lives without the need to have frequent sex, it should be noted that physical health is more closely associated with sexual dysfunction than age alone.