We Need to Talk About Sex: Older Adult Edition
/The first reaction of many people upon hearing that their grandparents may still be ‘getting some’, is to show a look of horror and say ‘I don’t want to think about it’. Despite sexuality being such a fundamental part of human nature, society seems to have assigned it an expiration date. And yet, statistics show that many older adults engage in sexual behaviour, and they consider it important to their lives and even actively express desire for intimacy, just as frequently as their younger contemporaries (Sousa et al., 2016). Despite this information, older adults face stigma from media that perpetuate negative myths and stereotypes about sexuality in later life; they may be negatively affected when these beliefs are upheld by themselves and others, including their health care providers. As a result, older adults often suffer from increased risk of disease, and they face issues to acquiring necessary treatment as well as other barriers to their sexual needs.
According to a cross-national survey conducted in the U.S, a fourth of older males aged 74-85, half of those between 65 and 74, and three-fourths of those aged 57-64 regularly engaged in sexual activity. Moreover, women showed similar results (Lindau et al., 2007). These data showcase that older adults are not asexual, as we are often led to believe. In spite of these findings, media often portray older adults in such ways, either by omitting older adults whenever sexuality is brought up (i.e., the lack of older adults in ‘sexy’ ads, such as lingerie ads) or in the perpetuation of negative stereotypes like ‘cougars’ or ‘dirty old men’ that shame the presence of sexuality in older adults, positing that it is ‘unnatural’ (Gewirtz-Meydan et al., 2018).
These stereotypes and myths are often then internalized by both older adults and other people, which in turn affects them in a number of ways. For example, older adults may feel shame with regards to intimacy, which then manifests in an unwillingness to discuss sexuality with their families or health care providers. This reluctance is problematic in a multitude of ways, and one reflection of this is in the rise of STI (sexually transmitted infection) diagnoses, such as HIV/AIDs, in older adults (Rheaume & Ethel, 2008). Given that today’s older adults had grown up in a time in which talking about sexuality was more taboo than it is now, there is a knowledge gap that exists in terms of STI protection and on how to negotiate for safe sex with new partners (Reissing & Armstrong, 2017). If older adults are unwilling to disclose information regarding their sexual history to health care professionals, the gap is not filled, and the consequences may be dire. Despite being at a higher risk for STIs than younger people because of their lower immune system functioning and other vulnerabilities related to aging (Reissing & Armstrong, 2017), older adults are less likely to take precautions as they do not believe themselves to be susceptible (Sousa et al., 2016), thereby leading to a greater number of STIs in older adults.
Internalization of myths and stereotypes do not only affect older adults directly, but also indirectly. Lack of knowledge and the presence of age-related bias in practitioners are common. In one study, physicians reported that they felt that they were insufficiently educated in sexuality in later life and therefore did not discuss sexual issues with their older patients. A study of psychiatrists also revealed that they often omit questions about sexual history in their assessment of older men, which often led to inappropriate referrals and treatments (Gewirtz-Meydan et al., 2018). Even when sexual dysfunction is raised, bias is evident: although a clinician may view it as ‘treatable’ in a younger patient, it is viewed as ‘normal’ in an older patient (Sousa et al., 2016). This bias is also a reflection of a dichotomy in which it seems that two models are being used in the approach to sexual problems depending on age. With younger patients, practitioners adopt a biopsychosocial model (i.e. taking an interdisciplinary approach that take into consideration the biological, psychological and social factors in diagnosis) (Gewirtz-Meydan et al., 2018), which is currently being recommended in the field, and yet defaulting to a purely medical model (i.e. the classic approach—insinuates that biological and psychological aspects should be treated separately) (Swaine, 2011) for older adults, ignoring any psychological and social factors that could be coming into play (Estill et al., 2017). As such, older patients do not receive the treatment that they need, or they receive inappropriate treatment.
Furthermore, in many long-term care homes, staff members often hold negative views with regards to any sort of ‘sexual expression’ displayed by their residents. Not only that, but the settings themselves are often not conducive in allowing residents access to their sexual rights, considering the lack of privacy and the stigma that may be incurred if their sexual behaviour was discovered by staff or by other residents (Rheaume & Ethel, 2008). Therefore, many patients in long-term care are unable to have their sexual needs met, and the attitudes of staff only serve to further deepen the myths and stereotypes regarding sexuality in older adults.
Despite these negative findings, there has been research conducted on ways to reduce ageism—that is, prejudice or discrimination based on someone’s age—in sexuality. One of the most notable methods has been education targeted towards health care providers. It has been seen that education in health care providers is essential in eliminating negative stereotypes and views about sexuality in later life (Gewirtz-Meydan et al., 2018). Such education typically would encompass how to recognize cues of desire in older adults, address methods in which staff may facilitate a patient’s sexual expression, and provide skills for the dismantling of stereotypes. Furthermore, privacy policies, such as simple ‘do not disturb’ signs may help in providing private environments for said sexual expression (Rheaume & Ethel, 2008).
Research has also shown that older adults, like younger adults, vary in sexual expression. Sexuality often shifts to non-genital intimacy. As such, health care providers can also be trained to consider sexuality in a broader sense and how to develop treatment plans that include this expanded approach to sexuality (Rheaume & Ethel, 2008). Once trained, practitioners can then help by promoting more realistic attitudes towards sexuality in older adults and guide patients in expanding their sexual repertoire so that their expression of sexual identity becomes consistent with their reality, instead of trying to force themselves into a standard model that is protrayed by media (Gewirtz-Meydan et al., 2018). This shift may also help reduce the effect on internalized stigma older adults may have towards themselves.
Society as a whole can also participate by putting an end to our beliefs in the myths about sexuality in old age and begin to hold open, inclusive discussions about sexuality in all phases of life. We should advocate for positive media – for the end of the perceived mutual exclusivity between sexuality and old age and the end of the taboo over sexuality in later life. We should hold and encourage the discussion about sexuality in later life, to assure that people, regardless of age, feel comfortable in expressing their sexuality and advocate for their sexual health.
In conclusion, bias and stereotypes about sexuality in older adults have been internalized by our society, and they are reflected in the absence or mockery of sexuality in later life by media, in the reluctance to speak about sexuality on the part of older adults themselves, and in the biases of many health care providers. Such negativity may affect older adults as it may lead to an increase in STI transmission risk, difficulty in accessing necessary treatment, and form barriers to their sexual needs. However, as a society, we can end ageism in sexuality through proper education in our health care providers, the adoption of new policies that would allow for an appropriate environment for sexual expression in long-term care homes, the development of positive, inclusive media about sexuality in older adults, and transformative thinking about sex.
As such, maybe we should stop talking about what sex “should” be—this idealized version of sex targeted towards only young couples. Maybe we should stop marginalizing those that don’t fit within what society has defined as “typical”, like older adults. After all, sexual rights are a part of our human rights, and they should be accessible to everyone without stigma or fear of negative consequences. So, maybe we should forget about what sex should be and instead, talk about what sex could be—and that includes having ‘sexy’ grandparents.
Eva Lan
4th Year BAH Linguistics, Queen’s University
References
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Gewirtz-Meydan, Ateret, et al. “Ageism and Sexuality.” International Perspectives on Aging Contemporary Perspectives on Ageism, 2018, pp. 149–162., doi:10.1007/978-3-319-73820-8_10.
Lindau, Stacy Tessler, et al. “A Study of Sexuality and Health among Older Adults in the United States.” New England Journal of Medicine, vol. 357, no. 8, 2007, pp. 762–774., doi:10.1056/nejmoa067423.
Reissing, Elke, and Armstrong, Heather. Human Sexuality: a Contemporary Introduction. OUP Canada, 2017.
Rheaume, Chris, and Ethel Mitty. “Sexuality and Intimacy in Older Adults.” Geriatric Nursing, vol. 29, no. 5, 2008, pp. 342–349., doi:10.1016/j.gerinurse.2008.08.004.
Sousa, Avinash De, et al. “Sexuality in Older Adults: Clinical and Psychosocial Dilemmas.” Journal of Geriatric Mental Health, vol. 3, no. 2, 2016, p. 131., doi:10.4103/2348-9995.195629.
Swaine Z. (2011) Medical Model. In: Kreutzer J.S., DeLuca J., Caplan B. (eds) Encyclopedia of Clinical Neuropsychology. Springer, New York, NY