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Running head: SEXUALITY AMONG OLDER ADULTS 1

Sexuality Among Older Adults

Taylor R. Holmes

Briar Cliff University


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Table of Contents

Abstract................................................................................................................................3

Sexuality Among Older Adults............................................................................................4

References..........................................................................................................................11
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Abstract

This paper will serve as a literature review of articles related to the topic of sexuality in late

adulthood. The aging process naturally affects sexual functioning by way of menopause in

women and the decrease in testosterone in men. The ways these physiological factors affect

sexuality will be analyzed. This paper will also analyze the unique barriers older adults face that

prevent them from having a fulfilling sex life. These barriers include illnesses associated with

aging, such as dementia, and the ability to consent, attitudes about aging, and sexual difficulties,

such as problems with arousal or climax. This paper will also discuss the importance of sexual

relationships in late adulthood and how they compare across the life span. Lastly, considering all

this information, this paper will discuss ways society and healthcare practitioners can support

elders in having and maintaining healthy, satisfying sex lives.

Keywords: sexuality, late adulthood, older adults, elderly


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Sexuality Among Older Adults

For some reason, the topic of sexuality as it pertains to older adults is treated as taboo or

inappropriate. As a society, it seems as though the thought of adults continuing to have sexual

relationships well into old age is an uncomfortable conversation. However, the fact of the matter

is that even in late adulthood, older adults are still human beings with human desires, including

sexual desires. This paper will serve as a literature review over current research regarding

sexuality and sexual relationships in late adulthood. This paper will discuss just how the aging

process affects sexuality, how important sexual relationships are among older adults, and what

barriers may exist for creating and maintaining this healthy sex life and how healthcare providers

and social systems can support older adults.

In order to begin the conversation about continuing sexuality as an individual ages, a

good starting point would be to analyze just how sexuality is affected by the aging process.

Aging begins to affect people usually around middle adulthood, around 45 years of age. These

changes consist of testosterone and estrogen levels in men declining, and women entering

menopause and the accompanying decrease in androgens and estrogen. In both men and women,

these changes can affect muscle strength, bone mass, inflammatory processes and sexual

functioning, such as erectile dysfunction in men and urogenital atrophy in women (Buttaro,

Koeniger-Donohue, & Hawkins, 2014). Sexual functioning is not only affected by the

physiological effects of aging. Factors such as obesity, hypertension, diabetes, lack of exercise,

incontinence, and alcohol/drug use can cause sexual dysfunction in older adults (Buttaro,

Koeniger-Donohue, & Hawkins, 2014).

Some students in this class likely have parents around 45 and it would be a safe

assumption to believe that they are still sexually active with their partners. However, at some
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point, society assumes for people over a certain age to be asexual. Knowing this to be false in

most cases, the next question that should be asked is: just how important is sex as one ages?

Research shows that people continue sexual relationships well into their 80s, and sexual identity

remains important to individuals across their lifespans (Fileborn et al., 2017). As shown in the

study conducted by Buttaro, Koeniger-Donohue, & Hawkins (2014), sexual functioning may

follow a linear decline model, meaning as an individual’s age rises, their ability to function

sexually decreases. However, Fileborn et al. (2017) suggest that even though this functioning

may decline, sexual desire or pleasure do not follow the same model. Fileborn et al. (2017) also

suggests that older people still lead, or have a desire to lead, complex sexual lives. Fileborn et al.

(2017) conducted in-depth qualitative interviews with 27 Australian heterosexual men aged 60

and over in order to better understand how older men define sex and sexual pleasure, the

importance place on sexual relationships and pleasure as they age, and how they adjust sexual

practices to accommodate the aging process. The study found that most participants still viewed

sex as an essential aspect of their life. The reasons given for their high ratings of importance

included sex being integral to manhood, dependent on context and the relationship, more

important in the long-term, the role sex plays in bonding and maintaining intimacy, sex as a sign

of trust, respect and understanding in relationships. Participants also reported that sex is

important even in old age because sex relieves stress, it is enjoyable, fun, pleasurable, mood

altering, and a fundamental aspect of human behavior (Fileborn, 2017). While this study only

represents a small population of less than 30 heterosexual men, it can be used to generally infer

that sex remains an important aspect of human experience across the lifespan.

There are also various barriers that exist for creating and maintaining healthy sexual

relationships throughout late adulthood. One barrier is the complexity of consent when an older
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individual has an illness or degenerative disease such as dementia, particularly adults living in

assisted living facilities. Again, society would rather not discuss the elderly having sex, so many

assisted living facilities tend to turn a blind eye or react poorly to sexual encounters between

residents. This is especially true when the resident has dementia. Facilities have a tendency to

become apprehensive out of fear of upholding their duties of care, concerns about unlawful acts,

potential risks posed to the resident, and negative reactions from resident families (Tarzia,

Fetherstonhaugh, & Bauer 2012). The presence of dementia also calls into question the capacity

of a resident to consent to sexual activity between themselves and another resident. At the middle

of many debates regarding consent lies diseases like dementia. Dementia is characterized by

changes in behavior, memory loss, and a decline in cognitive impairment that may prevent an

individual from being able to accurately vocalize their decisions. This complicates the view of

whether or not someone with dementia can fully understand the implications of a sexual

relationship and being able to consent to engaging in a sexual relationship (Tarzia,

Fetherstonhaugh, & Bauer, 2012). When discussing one’s ability to consent, one capacity

assessment tool suggests the individual must be able to “communicate a choice; understand the

relevant information; appreciate the situation and its consequences; and display reasoning”

(Tarzia, Fetherstonhaugh, & Bauer, 2012). Tarzia, Fetherstonhaugh, & Bauer (2012) suggest that

frameworks like this do not take into account the varying levels of capacity needed for decision-

making depending on the situation; like a life-or-death situation or deciding what flavor of ice

cream to get and sexual decisions are like ice cream. Some experts believe that capacity should

be assumed, and it is left on the facility to prove without a doubt that an individual does not have

this decision-making capability. This assumption could pose a risk, however, leaving elders

vulnerable. Tarzia, Fetherstonhaugh, & Bauer (2012) argue that the medicalization of dementia
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and the overprotection of vulnerable populations like the elderly infringes on their right to

autonomy and sexual freedom. Studies also show that although an individual may not be able to

vocalize their emotions or consent, people with any stage of dementia have the ability to make

and communicate a choice or preference. This was established following a study that assess

resident enjoyment of an art program. Positive indicators of enjoyment consisted of “verbal

expression of pleasure while participating in the actual activity; eyes crinkled, smiles, laughter,

relaxed facial expression; nods positively, relaxed body language” while negative indicators

consisted of “closed body language, frown on face, angry verbal outbursts; facial grimacing, or

brows furrowed; psychomotor agitation (hand tapping, moving in chair, leg jiggling, wincing);

rapid brea thing, eyes wide, frightened look” (Tarzia, Fetherstonhaugh, & Bauer, 2012).

Another barrier to creating or maintaining sexual relationships in late adulthood is the

individual’s own attitude on aging. Estill, Mock, Schryer, & Eibach (2018) studied how an

individual’s subjective age, the difference between how old they feel and their chronological age,

and their attitudes regarding age affected their sexual lives. They administered a survey to 1,006

Americans, age 40 and over. The survey found that the older an individual feels, the less quality

sex they experience and positive attitudes about aging predicted higher levels of quality sex. The

older an individual’s subjective age was, the more likely they were to show a lower interest in

sex. The only thing not affected by subjective age and aging attitudes was the frequency at which

the participants engaged in sexual activity (Estill, Mock, Schryer, & Eibach, 2018). The study

also found that frequency of sex seemed to be constant over time; participants who reported

having frequent sexual encounters at the beginning of the study still reported frequent sexual

encounters 10 years later (Estill, Mock, Schryer, & Eibach, 2018). While this study highlights

some barriers to a healthy sex life, it shines a light on factors healthcare workers can focus on
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when discussing sexuality with older adults. By reinforcing positive stereotypes about aging and

sexuality, as well as helping older adults feel as young as possible, healthcare workers can

support older adults in a healthy sex life.

The last barriers to a healthy sex life that older adults experience are difficulties

becoming sexually aroused and difficulties achieving an orgasm. Galinsky (2012) performed a

study consisting of 1,352 seniors, ages 57-85 and living in an assisted living community, who

participated in a national survey and had had sex in the past year. The purpose of the study was

to test the variables of sexual difficulties, sexual arousal and sexual pleasure, and how sexual

touching (kissing, hugging, caressing, etc) related to these variables. 79.8% of participants

reported that their sexual encounters over the past 12 months always included kissing, hugging,

caressing, and other sexual touch. Women were more likely to report a lack of pleasure from sex

and an inability to climax during sex. 37.1% of men reported difficulties getting or maintaining

an erection, while 39% of women reported difficulty with vaginal lubrication (Galinsky, 2012).

The results of the study found that older adults who make any form of sexual touch routine in

their sexual encounters were more likely to report high levels of physical pleasure within their

romantic relationships (Galinsky, 2012). This study suggests that while other research has

focused on physiological, psychological and life history as it pertains to sexual difficulties and

pharmaceutical interventions, for some older adults, simple sexual touch may be enough to

increase sexual stimulation and pleasure.

While aging presents a unique set of barriers to a healthy sex life for older adults, there

are ways healthcare workers and social systems can support them in overcoming these barriers.

The first thing that needs to happen to support seniors in their continued sexuality is to start

talking openly and honestly about it. The discomfort behind this topic stems from not wanting to
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see one’s own parents or grandparents in that way, but the fact of the matter is being sexual is

simply human nature. Sexuality and sexual relationships have a significant effect on the quality

of life one experiences throughout their life span. Sex is seen to enhance relationships and

provide a sense of intimacy platonic relationships cannot fulfill (Estill, Mock, Schryer, & Eibach,

2018). By accepting this fact, society can begin to dismantle the stereotypes that there is

something unnatural or “dirty” about older adults having sex (Estill, Mock, Schryer & Eibach,

2018). Healthcare workers can support older adults in their sexuality by ensuring older adults are

properly informed on exactly how to have healthy sex. People over the age of 50 have the fastest

growing prevalence of sexually transmitted diseases, including HIV/AIDS (Buttaro, Koeniger-

Donohue, & Hawkins, 2014). This can be attributed to the lack of doctors asking for past and

current sexual history, again due (at least in part) to discomfort about the topic as a whole.

Healthcare workers and support systems, to include family and friends, can support older adults

in meaningful is by encouraging them to be sexually creative and helping them understand that

sexuality does not only have to involve penetration. By getting society and older adults

comfortable with the idea of adults continuing to be sexual into late adulthood, more older adults

could get the assistance and support they need to fulfill their own sexual desires, should they

choose to do so.

In conclusion, the topic of sexuality in late adulthood is one that is not widely discussed

in society. This lack of openness only seems to confound the barriers posed by the effects of

aging that prevent healthy sexual encounters in late adulthood. The research done in the studies

discussed further prove that although it is expected for physical and cognitive functioning to

decline as one ages, the desire to create and maintain sexual relationships are constant. Older

adults engage in, or desire to engage in, sexual activity for the same reasons anyone else does:
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for intimacy, pleasure, to relieve stress, to express love, and to feel close to another human being

on a higher level among a plethora of other reasons. The aging process in itself affects sexuality

in adults starting as young as 45, however, this research has highlighted ways older adults can

continue to have fulfilling sexual relationships. This can be done by being creative, being open

and honest with loved ones and health practitioners, focusing on the passion and intimacy rather

than penetration itself, and dismantling negative aging stereotypes in general. By doing these

things, older adults can live their lives as freely (and safely) as they want without fear of

judgement, and society can support the happiness and satisfaction of its elders, which ultimately

benefits society as a whole in the long run.


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References

Buttaro, T. M., Koeniger-Donohue, R., & Hawkins, J. (2014). Sexuality and quality of life in

aging: Implications for practice. The Journal for Nurse Practitioners, 10(7), 480-485.

doi: http://dx.doi.org.briarcliff.idm.oclc.org/10.1016/j.nurpra.2014.04.008

Estill, A., Mock, S. E., Schryer, E., & Eibach, R. P. (2018). The Effects of Subjective Age and

Aging Attitudes on Mid- to Late-Life Sexuality. Journal of Sex Research, 55(2), 146–151.

https://doi-org.briarcliff.idm.oclc.org/10.1080/00224499.2017.1293603

Fileborn, B., Hinchliff, S., Lyons, A., Heywood, W., Minichiello, V., Brown, G., Malta, S.,

Barrett, C., Crameri, P. (2017). The importance of sex and the meaning of sex and sexual

pleasure for men aged 60 and older who engage in heterosexual relationships: Findings

from a qualitative interview study. Archives of Sexual Behavior, 46(7), 2097-2110. doi:

http://dx.doi.org.briarcliff.idm.oclc.org/10.1007/s10508-016-0918-9

Galinsky, A. M. (2012). Sexual touching and difficulties with sexual arousal and orgasm among

U.S. older adults. Archives of Sexual Behavior,  41(4), 875-90. doi:

http://dx.doi.org.briarcliff.idm.oclc.org/10.1007/s10508-011-9873-7

Tarzia, L., Fetherstonhaugh, D., & Bauer, M. (2012). Dementia, sexuality and consent in

residential aged care facilities. Journal of Medical Ethics, 38(10), 609. doi:

http://dx.doi.org.briarcliff.idm.oclc.org/10.1136/medethics-2011-100453