Many people find the idea of older people having sex disgusting to the point of absurdity. Older people’s sexuality is often exploited for laughs on television or casually mocked. While it is true that sex often becomes more difficult as one gets older, and the level of desire for sex often changes, the need for intimacy often remains constant over a lifetime. This enduring human need passes largely under the radar because of the social stigma against older adults’ sexual activity and aging.
It is hard to say whether the social stigma has limited research in these areas, or whether stigma comes in part from the lack of information. It may be both. In either case, the study of older people’s sexuality is a relatively young field in Western medicine, and American sexuality researchers’ data on that demographic is limited. Results of those studies might have limited relevance to non-heterosexual and non-Western people . However, it is known that older adults are interested in having sex. In a recent study by Lindau et al., 73% of survey participants who were 57 to 64 years old, 53% who were 65 to 74, and 26% who were 75 to 85 had had sex with someone within a year prior to the study .
Although many older people have been sexually active for decades, they do not necessarily have complete and up-to-date information. Many do not know sex education basics, or think that the information no longer applies to them. This is not a small-scale problem. In a recent cross-sectional study of Chicago women ages 58 through 93, nearly 60% of single women who had been sexually active in the previous ten years reported that they had not used a condom; 21% of women with a current sexual partner agreed that condom use is not necessary “if you can no longer get pregnant” .
Older adults’ sexuality frequently does not get addressed alongside other health issues as they age. Health care providers are reluctant to initiate conversations about sex with them, particularly when a large age difference exists between doctor and patient, although the recent invention of drugs for male erectile dysfunction mean that older men often get more medical attention to sexuality than older women, and the notable human papillomavirus (HPV) awareness campaign has reached women of all ages in clinical visits, in magazines, and on television [1, 3, 4]. For the most part public health campaigns do not target older adults. If they do, older adults’ sexual health issues are often treated as disease and degeneracy that needs to be corrected. Undiagnosed or untreated sexual problems can lead to or occur with depression and social withdrawal, and the disapproval of friends and family may make it less likely that older adults will talk about their needs and issues . Assumptions about older adults’ sexuality affect the care they receive.
Like all prejudices, social stigma against older adults’ sexuality creates problems in many sectors. Efforts to mitigate the medical and social problems frequently focus on advocacy and spreading information. The American Association of Retired Persons (AARP), one of the most prominent membership organizations for people 50 years and up in the United States, advocates for and provides information on aging issues, including sexuality . Pre-dating Medicare, it was founded by Dr. Ethel Percy Andrus in 1958 to advocate for productive aging and obtain insurance for older people, which at the time was virtually nonexistent . It frequently commissions surveys on sexual attitudes and practices among older adults. The online and print newsletters publish sex advice aimed at the baby boomer generation.
While such efforts deserve praise, they do not get to the heart of the problem: failure to defend the right to intimacy from older people’s perspective. The prevailing youth-centric definition of sexuality, emphasizing intercourse and strong desire for it, portrays sexuality in old age as abnormal. It rejects the need to be desired and loved on grounds of age. On the contrary, sexuality is not just about having sex, and health means more than being free of disease and infection. Condemning older people’s sex implies that their need for physical and emotional intimacy is not valid. These basic human needs do not have age limits.
A recent Fulbright scholar, Andy Chen, raised these issues in his scholarship project. Entitled Imaging Intimacy, it is a work of graphic design and ethnography developed from extensive interviews with a small but diverse set of adults ages 51 to 75, gay and straight, transgender, male and female, committed and single. In the written portion, he explained how he used these interviews to develop images that explore questions such as, what does sex mean for older people? How do older people view themselves? What are their social networks, what sources do they trust, and with whom do they communicate to get information? “The design process detailed in this book offers an inclusive approach: by advancing the argument that all people need intimacy and interaction, we hope to address implicitly the broader concerns surrounding loneliness and isolation in later life. Our ultimate goal is to promote older people’s ability to make informed decisions about their sex lives – free of shame, fear, violence, disease, and misinformation,” he wrote .
There are many approaches that can be taken to help older adults take control of their sexual health. Researchers from the University of Chicago have created the National Social Life, Health, and Aging Project (NSHAP), a study on the role that social relations play in health as people age. Its end goal is to improve quality of life during aging. Unlike many previous studies, it surveyed a nationwide, nationally representative set of people, and its data will be made publicly available for research. It is population-based: it puts individual patient care in the context of groups of people with similar needs, with the aim of improving a group’s health without sacrificing the quality of individual care. They interviewed and collected measurements from 3,000 older adults in 2005 and 2006, and will interview them again in 2010 and 2011 .
The unprecedented scope of the NSHAP is also significant. According to U. S. Census projections, people age 65 and older will constitute 19.6% of the national population by 2030 . While countries have historically reached developed status before aging, the birth rates in developing countries such as China and India are also dropping so quickly that their populations will age before their economies are considered developed. Issues concerning older adults will be magnified worldwide during the coming decades. Such studies will be valuable data collection models and sources of information for researchers all over the world.
Social stigma against older adults’ sexuality has a significant impact on health. But the health care problems it creates also call for a concerted effort to change perceptions. The goal should be to educate the general public, not just older adults or teenagers, about how sexuality changes through a lifetime. Arguing that older people should not need or want sexual intimacy is dehumanizing, and old age is a demographic category that most people will eventually join. It would be a shame for young people to wait until old age to attempt to correct this social stigma upon discovering that they are very much the same people inside as when they were young.
- Lindau ST, Gavrilova N. Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of aging. BMJ. 2010; 340:c810.
- Lindau ST, Leitsch SA, Lundberg KL, Jerome J. Older women’s attitueds, behavior, and communication about sex and HIV: a community-based study. J Womens Health (Larchmt) 2006; 15:747-53.
- Lindau T, Schumm P, Laumann EO, Levinson W, O’Muircheartaigh C, Waite L. A national study of sexuality and health among older adults in the US. N Engl J Med. 2007; 357:22-34.
- Friedman AL, Shepheard H. Exploring the knowledge, attitudes, beliefs, and communication preferences of the general public regarding HPV: findings from CC focus group research and implications for practice. Health Educ Behav. 2007; 34:471-485.
- Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ. A study of sexuality among older adults in the United States. N Engl J Med. 2007; 357(8):762-774.
- U. S. Census Bureau. U. S. Interim Projections by Age, Sex, Race, and Hispanic Origin, Table 2a. 2004 [cited 2011 May 14]. Available from: http://www.census.gov/ipc/www/usinterimproj/.
- Chen A. Imaging Intimacy. London: Helen Hamlyn Centre, Royal College of Art; 2010.
- American Association of Retired Persons. AARP History [homepage on the Internet]. Washington: AARP; [cited 2011 Aug 9]. Available from: http://www.aarp.org/about-aarp/info-2009/History.html.
- National Opinion Research Center [homepage on the Internet]. National Social Life, Health, and Aging Project [cited 2011 Aug 9]. Available from: http://www.norc.org/nshap.