A decrease in the rate of global mortality, paired with an aging generation of baby boomers, means that the current demographic of older adults is rapidly expanding — and with that, the scope of their sex lives.
There is a substantial amount of evidence, after all, that lifelong sexual function can be considered an essential facet of what it means to achieve successful aging, with a large range of ensuing implications for other aspects of life, in general.
However, some of the challenges faced by aging individuals include social and/or self-stigma, the perpetuation of sexual myths and misinformation, lack of STI prevention programs, and the failure within nursing homes and healthcare facilities to adequately support individuals in these areas.
In other words: it’s time to get busy helping others….well…get busy.
First things first.
Sexuality can be considered an essential component of a person’s identity, and although it is largely recognized as a fundamental part of the human experience, the needs of older individuals to express their sexuality is often entirely neglected.
The concept of sexuality is often associated with sexual acts, or the outward display of sexual orientation, despite the parameters of the definition not being intrinsically bound by these constraints.
More encompassing definitions of the term, however, have shifted to include broader notions of intimacy and the mind, body, and soul experience, even in the absence of conventional sexual behaviours and activities. The use of the word, ‘conventional,’ here, is also illustrative of the disconnect between what is considered to be socially acceptable for aging individuals, and what the reality of their desires and sexual urges is.
Psychological research on the phenomenon of the discrepancy between the way older people are perceived to regard sexuality, and the way they actually do, remains rudimentary, yet has already facilitated the very early stages of a shift in social consideration. Typically, there exists the inaccurate assumption that with old age comes asexuality, alongside the perpetuation of harmful myths and general neglect of discussions revolving around the subject.
Whilst aging is characterized by changes of a physiological, behavioural, psycho-social, and pathological nature, it is necessary to disentangle the reality of the individual from the stereotype. Something referred to as the cringe factor recently emerged as an explanation for this occurrence, one that is especially pervasive within the healthcare and nursing care sectors.
The cringe factor is defined by the belief that sexual activity is reserved for the young, and that the notion of older adults engaging in the action is something disgusting or unnatural. As a result, both social and self-stigma are likely to impact aged individuals through the psychological internalization of these distorted beliefs, which bears inherent consequences for the well-being of the demographic, in more ways than one.
Not only might older adults feel hesitant to express their sexuality or continue to lead satisfying sex lives, but they are also dramatically less likely to seek help from healthcare providers for issues that relate to sexual functioning. This has got to change.
Research involving the analysis of gender disparities in sexual desire found that, additionally, married women over the age of 60 are likely to downplay or minimize the expression of their sexuality as a consequence of cultural norms pertaining to the marital convention in old age. These conclusions come despite the well-established acknowledgment that men and women attribute equal importance to sexuality, and that negative schematic (mental) representations of sex in older age are caused more so by socially-reinforced expectations, than biological or hormonal reductions in sexual desire.
In turn, this only strengthens the perceived validity of the stigma around sexuality and results negatively in an increased likelihood for individuals to experience a lack of knowledge surrounding the evolving nature of sexuality in older age.
Let’s talk about sex.
Interestingly, studies have demonstrated that this tendency to refrain from seeking a clearer understanding of the subject of sex and sexuality for older adults is not a result of an increase in modesty and/or shyness associated with the topic of sex itself.
Data from the Human Relations Area Files was collected in order to examine the socio-cultural intricacies in the attitudes towards sex held by older individuals of 106 traditional societies. This single study, in particular, revealed that a lessening of inhibitions related to the discussion of sexual topics, sexual humour, as well as the display of sexual gestures, was observed in 22% of these societies!
The findings largely contradict the widely held belief that older individuals would experience an increase in sensitivity to the appropriateness of the topic of sex, indicating that a reticence to seek medical advice or information on the subject, may, in actuality, result from more from social stigma and inadequate support from the healthcare system, than personal reservation.
Also outlined within the literature is the existence of a ‘permission-granting’ role of healthcare providers when it comes to addressing the relationship between experienced sexuality and aging.
In this sense, a trend was identified among care professionals for the scope of sexual health management to extend beyond the addressing of problems of sexuality themselves, to include moral validation or ‘permission-granting’ of the on-going experiencing of sexuality itself.
The notion that older people may perceive their on-going sexuality — especially within the context of forming a new relationship following a divorce or widowing — as something that requires ethical approval from a licensed physician, serves to highlight the high prevalence of psychological guilt or internalization of the social stigma that accompanies the relationship between sexuality and aging.
While the regarding of a physician as being a valid purveyor of moral arbitration is far from a novel concept within academia, the examination of the physician’s perspective on this phenomenon, as it relates directly to sexuality and aging, has only very recently been contextualized.
Qualitative research has found that many healthcare providers are able to acknowledge the limitations of their beliefs concerning sexuality in later life as being founded mostly in supposition and stereotype as opposed to the reality of the patient’s experience. Further to this, details of sexual history and STI status are often likely to be omitted entirely during psychiatric interviews with the elderly out of the fear of indecorum or unprofessionalism.
The decision of whether or not to provide care and support to older individuals in areas involving sex and sexuality is therefore significantly likely to be influenced by the caregiver or physician’s own psycho-social biases, in turn, affecting the perceived appropriateness for the adult to initiate these conversations, themself. The paired assumption that adults lose their sexual desires as they enter old age is largely paralleled by the idea that individuals in their old age are universally unable to sexually perform.
Not only are these assumptions false, but they also prove to be dangerous when it comes to creating challenges of health and safety, as a result of inadequate education in these areas. For example, an approximate 12–22% of all newly diagnosed cases of AIDS are among individuals over the age of 65.
Despite the rates of sexually transmitted infections being expected to continue to rise for middle and older-aged adults worldwide, HIV testing (at least within the United States) is only mandated for those 64 years of age and below, with no additional age-related prevention programmes in place.
The takeaway.
Although the prevalence of STIs peaks for populations in their 20’s, the failure on behalf of the healthcare system to recognize the need for the provision of education on sexual risk-taking for all age groups has resulted in the erroneous conclusion that older people are not having sex.
In fact, according to the Human Relations Area Files, within the societies for which quantitative information on the sexual behaviour of older adults was available, it was found that 70% of men continued to engage in sexual activity of various kinds, while 84% of women expressed the same interest.
Though physiological changes in the sexual response cycle do occur for both men and women with age, the wide range of individual differences in the occurrence of these changes makes for a vastly varied experience of sex and intimacy for aging adults.
While the variation between individuals can, potentially, be accounted for by a mixture of general health factors, studies have provided further evidence that the continuation of sexual activity into old age actively lessens the degree of the changes associated with sexual health that may be experienced. Following this, it can be said that sexual activity is not only normal, but that it is a beneficial, if not crucial, area of functioning for many older adults, and one where they may suffer considerable concern.
Overall, the research we do have on the subject largely points to the notion that individuals are never too old to enjoy a healthy and happy sex life, with the sexual capability of individuals in their 50s, 60s, and even 70s, far exceeding what is socially recognized and/or supported.
Let’s hope this reality changes in the near future —fornication fifties and (safely) sexually-active sixties — here we come!
Alexandra Walker-Jones — December 2020
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