Elderly, Sex Among

As people age, a number of biological, psychological, and social changes occur, some of which may have an impact on sexuality and sexual expression. However, there is a paucity of information about sex among the elderly. Traditionally, sexuality has been considered the purview of the young and thought of as antithetical to aging persons. Research and textbooks on sexuality, marriage, and the family and even those on aging often do not devote much, if any, space to discussions of sex among the elderly.

The assumption has been that sexuality is something that occurs in youth and declines with age to the point where the elderly are seen as asexual beings for whom the expression of sexual interest is considered inappropriate or even deviant. Few research studies include elderly respondents, and those which do often use such small samples that it is difficult to generalize to the larger elderly population. As a result of the paucity of research on this topic and the small samples used in the few available studies, it is important to be cautious in generalizing research findings in this area of study.

The landmark research of William Masters and Virginia Johnson (1966) represented a breakthrough in sexuality research, especially as in relation to sexual behavior and the life course (those authors studied subjects of varying ages, including older subjects). Their findings suggested that interest in sex and the practice of sexual behaviors are not limited to the young but are lifelong. However, even after their study was published, most sexuality research continued to concentrate on the young. With increases in life expectancy and the growing number of elderly persons there is a need for more research in this important area of study. The baby boom generation, which had a significant impact on American sexual attitudes and behaviors when its members were young, is expected to have a significant impact on societal views of sex among the elderly. It is anticipated that researchers will pay more attention to sex among the elderly in the future.

INFLUENCES ON SEXUAL BEHAVIOR IN THE ELDERLY

Sexual interest and activities among the elderly tend to follow patterns set in middle age that are likely to continue into old age (Cox 2001). This suggests that a life course approach to sex among the elderly can be helpful in proving insights into cohort variability (Quadagno 2007). Sexual behavior patterns also are culturally influenced by ethnicity, socioeconomic status, sexual orientation, and religion (Kingsberg 2002).

Studies of sexual attitudes suggest that the importance the elderly attribute to sex in their lives tends to vary with their health and the availability of a partner (Gott and Hinchcliff 2003). Those in good health who have partners attribute some importance to sex in their lives, whereas those who experience barriers such as poor health and the lack of a partner appear to assign less importance to sex. Thus, it is not aging per se but age-associated changes in health or relationship status that appear to result in changing attitudes toward sex. Research suggests that for a variety of reasons women are more likely than men to experience those health and relationship barriers.

A number of biological changes occur in the reproductive systems of both men and women as part of the aging process. For women those changes include menopause: the cessation of menstruation and the traditional cessation of natural fertility. Some women experience hot flashes, night sweats, and other unpleasant symptoms during menopause, whereas others indicate that they experience hardly any noticeable effects. Research has suggested that the previous use of hormonal replacement therapies to overcome some of those negative experiences may have some risky side effects; those therapies no longer are used as widely and are employed with more caution. However, there continues to be interest in the use of hormone replacement therapy as a way of coping with a limited number of age-related changes or pathological conditions associated with aging, such as osteoporosis (Lemme 1999).

Changes in the reproductive system of men include declines in the level of testosterone among most men; also, some men may experience erectile dysfunction as they age. Prescription medications for some of those biological changes have been effective for many men. However, a number of men who have health problems such as diabetes and hypertension continue to report problems in that area. Testosterone replacement therapy is not in widespread use, and its long-term efficacy and side effects require further study (Lemme 1999).

LATE-LIFE DATING AND REMARRIAGE

Late-life dating and mate selection have increased greatly. Widows, widowers, and elderly divorcees no longer are expected to avoid the dating scene and forgo opportunities for developing new intimate relationships or remarriage. The rise of online Internet dating has led to not only an explosion of adult dating sites in general but the development of a number of sites devoted specifically to middle-aged and older daters.

Research on remarriage suggests that elderly males remarry at higher rates than do elderly females, especially among the widowed (Cox 2001). Two factors usually are said to account for this differential, one demographic and one cultural (Davidson 2002). Demographically there are more elderly women than elderly men, and culturally there is the expectation that in dating and marriage relationships the male partner will be the older person, thus giving heterosexual women an even smaller pool of candidates from which to make a selection. Elderly lesbians do not face the shortage of same-age eligible partners that affects elderly heterosexual women (Crooks and Baur 1993).

Additional research suggests that another factor that may account for fewer women remarrying is the desire among a significant number of women not to place themselves in a caretaking role. Those women indicate that they would like the companionship aspect of dating but not the caretaking responsibilities associated with the role of a wife (Davidson 2002). Despite the heightened level of Internet dating and new relationship formation, aging often is accompanied by a decline in new relationship formation among elderly men and especially among elderly heterosexual women (Davidson 2002).

The May-December relationship, in which the male partner is significantly older than the female partner, which always has been controversial but is a longtime staple of elderly male dating and sometimes marriage, has begun to occur among greater numbers of elderly women. Though it is more controversial than the male version, more elderly women have become receptive to dating younger partners, in some cases significantly younger. Though this pattern of older woman-younger man is increasing, it continues to be viewed more negatively socially than its counterpart, the older male-younger female relationship (Cox 2001).

Another area of controversy is late-life parenthood. Some men have fathered children well into their sixties, seventies, or even eighties. However, in those cases the woman usually is significantly younger, and it is she who is expected to raise the child. Thus, although concerns are expressed about whether late-life fatherhood may have a detrimental impact, such concerns usually are minimized. Increasingly, older, postmenopausal women (women in their fifties and even sixties) have chosen to become pregnant and achieve motherhood with the assistance of modern medicine. This practice, which has physical risks for both the mother and the baby, has been more controversial than late-life fatherhood, leading to more discussion of the issue of when is a person too old to become a parent.

PRIVACY ISSUES

Issues of privacy and sexual relationships among nursing home residents continue to be problematic. Research suggests that the rigid, Victorian negative attitudes of the nursing home staff and relatives toward intimate relationships among nursing home residents has moderated or disappeared. Some nursing homes have undergone significant changes in this area and reflect a more progressive view. However, there continues to be considerable variation from one nursing home to another. Even among nursing homes with a more progressive view, administrators face difficulties in deciding how to balance the desires of some residents for intimate relationships with issues of consent (especially as it may relate to cognitively impaired elderly residents), the sensitivities of family members about the sexual activities of their parents and/or grandparents, and, in the case of some religious institutions, religious precepts regarding the appropriateness of nonmarital or extramarital sexual relationships. In addition to all these issues, conjugal visits in nursing homes are even more difficult for homosexual couples than for their heterosexual counterparts.

Interest in sex and sexual expression continues throughout life for most people, yet age-related changes have a number of impacts on sexual behavior among the elderly. Further research is needed to provide insight into the biological, psychological, and social factors that have an impact on sex among the elderly.

BIBLIOGRAPHY

Cox, Harold G. 2001. Later Life: The Realities of Aging. Upper Saddle River, NJ: Prentice Hall.

Crooks, Robert, and Karla Baur. 1993. Our Sexuality. Redwood City, CA: Benjamin/Cummings.

Davidson, Kate. 2002. "Gender Differences in New Partnership Choices and Constraints for Older Widows and Widowers." Aging International 27(4): 43-60.

Gott, Merryn, and Sharon Hinchliff. 2003. "How Important Is Sex in Later Life? The Views of Older People." Social Science and Medicine 56: 1617-1628.

Kingsberg, Sheryl. 2002. "The Impact of Aging on Sexual Function in Women and Their Partners." Archives of Sexual Behavior 31(5): 431-437.

Lemme, Barbara Hansen. 1999. Development in Adulthood. Boston: Allyn and Bacon.

Masters, William H., and Virginia E. Johnson. 1966. Human Sexual Response. Boston: Little, Brown.

Quadagno, Jill. 2007. Aging and the Life Course: An Introduction to Social Gerontology. Boston: McGraw-Hill.

                            Susan Schuller Friedman