Sexuality and the elderly

1. Sexuality and the elderly By: Soraya Mehdizadeh

2. What is Sexuality? Sexuality: “Encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and relationships” (WHO, 2009)

3. What is Sexuality?-Cont’d Intrinsic vs. Socially Constructed?

4. Western Historical View of Sexuality in Late Life Middle Ages (Covey, 1989) • Older men who were able to maintain active sex lives were believed to have exceptional qualities, were given high social status, and it was thought to increase their life spans • Older women who were sexually active were thought to use witchcraft to trick men into going into bed with them

5. Modern Western Views of Sexuality in Late Life • Assumption that older people are asexual or impotent • Sexuality is taboo, unimportant, or irrelevant to older people • Aging is characterized by a continual physical and cognitive decline • The media associates sexuality with attractive youth, this shapes our beliefs about older people • Health researchers tend to overlook sexual views of older people • Aging heterosexual men have a greater choice of partners and expression of sexuality than older women (As cited in Bauer, McAuliffe, & Nay, 2007)

6. Sexuality and Aging: A study of 106 cultures (Winn & Newton, 1982)

7. Other Findings Related to Sexuality, Culture, & the Elderly • Kalaheri Desert, Africa • Elderly are valued and respected. • Females gain more social status with age • Female elderly status allows them to choose partners among the younger men • Abkhasians in the Caucasus • Men and women are sexual into old age (Encyclopedia for women and gender, 2002)

8. Traditional Chinese Taoists • Sexuality is considered healthy for the elderly • Inis Baeg of Ireland • Sex negative society • Postmenopausal women are seen as nonsexual and susceptible to mental illness • Uttar Pradesh in Northern India • Male-female sexual relations are suppose to end after the birth of their first son (Encyclopedia for women and gender, 2002)

9. Psychological Perspective: Why is sexuality important for the elderly? • Quality of life • Maintenance of healthy interpersonal relationships • Self-concept • Integrity • Self-worth • Mental health (Hajjar & Kamel, 2003; Zanni et al., 2003)

10. Theory of Development & Aging Erikson’s 8 Stages of Psychosocial Development • Unfolds according to both an innate scheme and one's up-bringing in a family that expresses the values of a culture • Each stage builds on the preceding stages, and paves the way for subsequent stages • Each stage is characterized by a psychosocial crisis, which is based on physiological development, but also on demands put on the individual by parents and/or society • Ideally, the crisis in each stage should be resolved by the ego in that stage, in order for development to proceed correctly

12. Biological Perspective: Sexuality in Late Life • Sexual Response cycle • drive, arousal, orgasm, resolution • Drive remains the same in both men and women, although frequency may decrease • Arousal is most affected by aging • Orgasm is least affected (although may require more time) • Refractory phase especially affected in older men (As cited in Sharpe, 2004)

13. Biological Perspective: Women • Shortening and narrowing of vagina • Less acidic vaginal secretions • Decreased estrogen levels (decreased clitoris size, graying of pubic hair) (As cited in Sharpe, 2004)

14. Biological Perspective: Men • Decreased production of testosterone • Testicles decrease in size and firmness • Sperm production is reduced • Prostate increases in size • Less pre-ejaculatory fluid • Less durable/ firm erections (As cited in Sharpe, 2004)

15. Health Related Barriers to Sexuality in Late Life • Parkinson’s Disease • Dementia • Rheumatoid Arthritis • Surgical Interventions • Alcohol Abuse • Incontinence • Diabetes/ hypertension/ stroke/ cardiac disease/ depression (As cited in Bauer, McAuliffe, & Nay, 2007)

16. STDs & HIV/AIDS in Late Life • Older adults account for 1.3% of all STDs • Most common STD in older women are genital herpes; in men, the most common is nongonoccoccalurethritis • Risks • Lack of knowledge and experience with condom use, decreased fears of pregnancy (Hillman, 2000) • Postmenopausal women are more susceptible to vaginal tears, allowing viruses greater access to the bloodstream • Cultural norms regarding sex • Lack of knowledge amongst the health care community • No national health campaigns exist regarding STD transmission, testing, or treatment for older adults (As cited in Hillman, 2008)

17. Social Barriers to Sexuality in Late Life: Healthcare Professionals • Ageism • Reluctant to discuss concerns with medical practitioners due to embarrassment, beliefs that their problems are simply due to normal aging • Particularly difficult for men • Doctors and physicians tend to generally be uncomfortable about raising the issue (As cited in Bauer, McAuliffe, & Nay, 2007)

18. Social Barriers to Sexuality in Late Life: Institutions • Healthcare institutions and nursing homes are generally not supportive of sexualized behaviour(Bauer, McAuliffe, & Nay, 2007) • Little consultation with residents about sexual needs; often it is viewed as an activity that should be curtailed (Hajjar & Kamael, 2003) • Psychological barriers such as threats and punishment have been used to control sexualized behaviour(Roach, 2004)

19. Social Barriers to Sexuality in Late Life: Partners • For women in particular, the availability of partners is an issue (Benbow & Jagus, 2002). • Loss of a partner/ bereavement • i.e. Widower’s syndrome (As cited in Sharpe, 2004)

20. CONCLUSIONS

21. Thank you for listening. Questions or comments?