The impact of experiences of ageism on sexual activity and interest in later life

Development of an Instrument to Assess Health and Social Care Professionals' Knowledge and Attitudes Towards Later-Life Intimacy and Sexuality (HSCP-KALLIS): A Delphi Study

AIMS

We aimed to ascertain the content validity of an instrument to assess health and social care professionals' knowledge and attitudes towards later-life intimacy and sexuality (HSCP-KALLIS).

BACKGROUND

For older adults, intimacy and sexuality are important in maintaining their quality of life and well-being. However, addressing these needs remains challenging for health and social care professionals, particularly for nursing staff providing 24-h direct care to older people with dementia or those identified as lesbian, gay, bisexual, transgender, intersex or queer/questioning individuals. Existing instruments assessing knowledge and attitudes towards later-life intimacy and sexuality are dated and fail to adequately address dementia and sexual diversity.

DESIGN

A two-round modified Delphi study was conducted.

METHODS

Initially, 79 knowledge and attitude items were generated through an integrative review. Panellists rated each item's clarity and importance using online questionnaires. The content validity index for the individual and overall items was calculated. The panellists' written feedback-along with their knowledge level of later-life intimacy and sexuality-was obtained.

RESULTS

Panellists included health and social care professionals (n = 9); healthcare-related educators (n = 2); researchers specialising in later-life intimacy, sexuality, dementia care and sexual diversity support (n = 7); and family carers of older people with dementia (n = 2). The instrument was revised based on the feedback received. The components of dementia, LGBTIQ+ and the provision of sex worker services in healthcare settings were highlighted by the panellists. Notably, 46 knowledge and 40 attitude items fulfilled the consensus criteria for clarity and importance.

CONCLUSIONS

Acceptable content validity was established for the knowledge and attitude items. Further research is required to establish the psychometric properties of the HSCP-KALLIS. This instrument has implications for clinical practice-specifically, in nursing care-by addressing issues to improve awareness regarding later-life intimacy and sexuality in healthcare settings.

IMPLICATIONS FOR PRACTICE

The HSCP-KALLIS has the potential to inform the educational needs regarding knowledge and attitudes towards later-life intimacy and sexuality for health and social care professionals, specifically nursing staff. The findings of the HSCP-KALLIS can be used for the development of competencies for later-life intimacy and sexuality, establishing policies and guidelines to support older adults' intimacy and sexuality needs in health care settings.

[Sexuality among the elderly: understanding the weight of stereotypes]

Sexuality is an integral part of health and accompanies human beings throughout their lives. It contributes to well-being and improves quality of life. The social representations conveyed by Western society modulate sexuality and can play a decisive role in the expression of seniors' sexuality.

The mediating role of self-directed ageism in sexual health among Jewish-Israeli older people

This article examines the relationships between physical health, personal resilience and healthy sexuality in older adults, and the mediating role of self-directed ageism in these relationships. Healthy sexuality, which encompasses sexual partnership satisfaction, sexual behaviors, successful sexual functioning, few negative changes, and few sexual health concerns, is important in old age. Five hundred Jewish-Israeli women and men, aged 60 years and over, participated in the study. Five questionnaires were administered that examined the number of diseases, level of resilience, self-perceptions of aging, and sexual relationships and activities. The data were analyzed using multiple linear and logistic regressions, and path analysis for the mediating role of self-directed ageism. The results showed that higher levels of resilience were positively related to aspects of sexual health, while reporting more diseases and higher self-directed ageism were negatively related to sexual health. Self-directed ageism mediated the relationships between resilience and number of diseases and sexual health. The findings supported the biopsychosocial model of healthy sexuality. It was concluded that sexual health in older age may be promoted by fostering resilience, promoting good health, and reducing self-directed ageism.

How Do Women and Men Negotiate Sex in Later Life Relationships? A Qualitative Analysis of Data from the English Longitudinal Study of Aging

Later life relationships and in particular the role of sex within them, have often been neglected in research due to assumptions of decline and sexlessness. We contribute to a growing body of work which counters these stereotypes by examining sexual scripts within the socio-cultural context of later life relationships. We analyzed open-text comments from the English Longitudinal Study of Aging (ELSA) collected as part of a self-completion questionnaire. In Wave 6, 1065 participants (M age 67.5, SD 9.6 years) and in Wave 8, 922 participants (M age 69.1, SD 9.01 years) responded to an open-text box question. Across both waves, 38% of respondents were men and 62% were women. The analysis used a coding template developed from existing literature and adjusted to accommodate emerging topics. A gendered analysis of the interrelated topics of relationships, sex and sexuality resulted in themes which illustrate similarities and differences in how men and women negotiate sex in later life relationships. The findings confirm that sex remains integral to intimacy in later life relationships for many men and women. However, they also demonstrate that norms of age and gender interact to shape sex and relationship practices in later life. These norms limit some people's experiences, for example, preventing them from seeking new relationships, as well as creating challenges for intimacy in partnerships. These findings extend the theoretical understanding of relationships and sex in later life.

Non-pharmacological interventions for the prevention of sexually transmitted infections (STIs) in older adults: A systematic review

BACKGROUND

STIs in older adults (adults aged 50 years and older) are on the rise due to variable levels of sex literacy and misperceived susceptibility to infections, among other factors. We systematically reviewed evidence on the effect of non-pharmacological interventions for the primary prevention of sexually transmitted infections (STIs) and high-risk sexual behaviour in older adults.

METHODS

We searched EMBASE, MEDLINE, PSYCINFO, Global Health and the Cochrane Library from inception until March 9th, 2022. We included RCTs, cluster-randomised trials, quasi-RCTs, interrupted time series (ITS) and controlled and uncontrolled before-and-after studies of non-pharmacological primary prevention interventions (e.g. educational and behaviour change interventions) in older adults, reporting either qualitative or quantitative findings. At least two review authors independently assessed the eligibility of articles and extracted data on main characteristics, risk of bias and study findings. Narrative synthesis was performed.

RESULTS

Ten studies (two RCTs, seven quasi-experiment studies and one qualitative study) were found to be eligible for this review. These interventions were mainly information, education and communication activities (IECs) aimed at fostering participants' knowledge on STIs and safer sex, mostly focused on HIV. Most studies used self-reported outcomes measuring knowledge and behaviour change related to HIV, STIs and safer sex. Studies generally reported an increase in STI/HIV knowledge. However, risk of bias was high or critical across all studies.

CONCLUSIONS

Literature on non-pharmacological interventions for older adults is sparse, particularly outside the US and for STIs other than HIV. There is evidence that IECs may improve short-term knowledge about STIs however, it is not clear this translates into long-term improvement or behaviour change as all studies included in this review had follow-up times of 3 months or less. More robust and higher-quality studies are needed in order to confirm the effectiveness of non-pharmacological primary prevention interventions for reducing STIs in the older adult population.

Changes and Forms of Sexual Behaviour in old age: A Qualitative Study of Older People in Southeastern Nigeria

The misconceptions that old age is an asexual phase of human life has been challenged by increasing empirical evidence which shows that sexual activity persists in old age albeit in different forms and frequency. This study examined how a group of older people in southeastern Nigeria express their sexual behaviour. The semi-structured individual interviews with 14 older people (9 male, 5 female) aged 60?89 years were conducted using an exploratory qualitative approach. The data generated were analysed thematically, and two themes were conceptualised including diverse sexual behaviour and mutual understanding. These themes supported a pattern among the participants where there is a drop in the frequency of physical sexual behaviour but their sexual interests were described to be more stable. However, the sexual interest is channelled into more intimate sexual behaviour. Thus, sexual behaviours in later life in this study were not declining but showed diversity and modifications; most have adjusted to incorporate more emotional bonding and caring. More so, what forms of sexual behaviour constitute for these older partners are often linked to the presence of dynamic interplay of influencing factors ingrained on the level of the older partners mutuality in understanding and responding to theencroaching age-related changes in their sexual behaviour. Remarkably, these factors could be controlled, which signposts a potential premise and point of policy and practical intervention to promote healthy sexual behaviour in later life.

Do Sexual Expectations Matter for Older Men and Women? Anticipated Sexual Futures and Late-Life Sexuality Over Two Decades

BACKGROUND AND OBJECTIVES

Expectations across a variety of life domains appear to shape the aging process, giving weight to the role of self-fulfilling prophecies in later life. Sexuality is one area where the power of expectations is not well-understood. We investigated whether 10-year sexual expectations were associated with sexual satisfaction and sexual frequency a decade on among older heterosexual coupled adults. We further examined whether sexual expectations could offset the sex-constraining impact of functional limitation onset.

RESEARCH DESIGN AND METHODS

We used 3 waves of the Midlife Development in the United States study (1995, 2005, 2014), a nationally representative panel survey. Analyses consider adults aged 45+ in 1995 who had a spouse or romantic partner at 2 consecutive waves. Associations between sexual expectations and eventual sexual satisfaction and frequency were estimated with multivariable generalized estimating equations. Moderation analyses examined whether between-wave onset of functional limitations had less influence on sexuality outcomes when combined with a high initial level of sexual expectations.

RESULTS

Sexually optimistic participants reported more sexual satisfaction and higher sexual frequency a decade later. Though the onset of functional limitations tended to suppress sexual frequency for women, the probability of having weekly sex was significantly higher among such women if they had high rather than low sexual expectations.

DISCUSSION AND IMPLICATIONS

Results suggest that, similar to other life domains, expectations shape the sexual experience of older adults. Clinicians and care providers may consider ways to help foster realistic optimism about sexuality among older men and women.

"I'm Too Old for That": The Role of Ageism and Sexual Dysfunctional Beliefs in Sexual Health in a Sample of Heterosexual and LGB Older Adults: A Pilot Study

The role of ageism (i.e., discrimination against individuals or groups on the basis of their age), in particular toward the sexuality of the elderly, remains, to date, an overlooked issue. A few studies have suggested that ageistic stereotypes can negatively affect older adults' sexual health. No data are available, in particular, about differences among heterosexual and LGB (lesbian, gay, and bisexual) populations. The present study aimed to investigate differences in perceived ageism and related dysfunctional beliefs in a sample of heterosexual (n = 104) and LGB (n = 103) older adults (aged 55 or older; mean age 66.5) and their impact on sexual health and satisfaction. LGB individuals reported higher rates of masturbation and sexual intercourse and an increased quality of sexual activity as compared to heterosexuals. In addition, no differences between the groups emerged as regards perceived ageism and dysfunctional beliefs toward ageing. In conclusion, LGB individuals perceived more ageism toward sexuality than their counterparts; however, heterosexuals were more likely to have dysfunctional beliefs toward sexuality in ageing. The study findings highlight the significance of examining sexual orientation to understand experiences of sexuality in ageing of the growing older population. Renewed socio-educational efforts based on these data are clearly needed.

Multidimensional Sexual Well-being Scale for Older Adults: Validity Evidence from a Polish Sample

Here, we report the results of a Polish adaptation of the Multidimensional Sexual Well-being Scale (MSWBS) for older adults. The MSWBS is a short self-report scale for assessing the five dimensions of an individual's sexual well-being: frequency of caressing, sexual intimacy, sexual compliance, sexual satisfaction, and sexual distress. The aim of our adaptation was to examine the utility of the scale in a country with conservative views on the sexuality of older people, which will help health care providers and researchers to better understand the sexual needs of older people. The study included 507 participants, aged 60-92. We found the reliability of the scale to be satisfactory (Cronbach's alpha = .71-.87). Confirmatory factor analysis (CFA) showed a good fit of the data to a five-factor model. This study demonstrates that the MSWBS-PL is connected to general life satisfaction and diversity of sexual activity, confirming the scale's validity.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2021.1991535.

Describing the "Gray" Area of Consent: A Comparison of Sexual Consent Understanding Across the Adult Lifespan

Sexual violence or misconduct can occur at any age, yet sexual consent understanding is not well studied, especially beyond early adulthood. This project aimed to describe how sexual consent is conceptualized across the adult lifespan, drawing comparisons between young, middle-aged, and older adults. Additionally, we examined variables that may differ by age group and influence sexual consent conceptualization. In a survey, young adults (n= 266), middle-aged adults (n= 236), and older adults (n= 51) were asked to define sexual consent and complete a measure on the appropriateness of giving and receiving consent in different types of sexual relationships. Participants also reported on their exposure to formal sex education and their current sexual relationship status. More than half (57.4%) of participants included basic elements of a simple core definition (agreement in reference to sexual acts), and most (63.3%) expanded beyond a simple definition. Age groups differed significantly on variables expected to influence sexual consent definitions, including exposure to sexual education and sexual consent attitudes. Age group differences were not found when examining the simple core definition, but young adults and middle-aged adults differed significantly in their expansion on the definition. Sexual consent attitudes were also significantly related to the scope of the supplied definition. These findings suggest that sexual consent definitions vary in scope across at least a portion of the lifespan and that the importance placed on sexual consent may be a reasonable intervention target regardless of age differences in sexual experience and education.

Sexual satisfaction of older adults: testing the Interpersonal Exchange Model of Sexual Satisfaction in the ageing population

Having a satisfying sex life is important to older adults. Thus, this study aimed to provide information about the sexual satisfaction of older adults in a relationship, using the Interpersonal Exchange Model of Sexual Satisfaction (IEMSS) as a theoretical framework. Participants were 187 sexually active individuals (98 men and 89 women) in a romantic relationship (age 65–75 years). They were recruited using Amazon's Mechanical-Turk, and completed the Interpersonal Exchange Model of Sexual Satisfaction Questionnaire and two open-ended questions asking what they enjoyed most and least about their sexual relationship. On average, participants were highly sexually satisfied. In keeping with the IEMSS, greater sexual satisfaction was predicted by a more favourable balance of sexual rewards to costs, greater equality of sexual costs and higher satisfaction with the non-sexual aspects of the relationship. Four themes emerged regarding what participants liked most and least about their sexual relationship: emotional aspects of the relationship, physical aspects of the relationship, dyadic aspects of the relationship and age-related aspects of being sexual. None of the four themes were specific to men or women, although some gender/sex differences were found. The results paint a positive picture of the sexual relationships of older adults and support the utility of the IEMSS as a framework to understand sexual satisfaction in older adults.

Age-related differences in valence and arousal of emotion concepts

Emotion concepts are representations that enable people to make sense of their own and others’ emotions. The present study, theoretically driven by the conceptual act theory, explores the overall spectrum of emotion concepts in older adults and compares them with the emotion concepts of younger adults. Data from 178 older adults (⩾55 years) and 176 younger adults (20–30 years) were collected using the Semantic Emotion Space Assessment task. The arousal and valence of 16 discrete emotions – anger, fear, sadness, happiness, disgust, hope, love, hate, contempt, guilt, compassion, shame, gratefulness, envy, disappointment, and jealousy – were rated by the participants on a graphic scale bar. The results show that (a) older and younger adults did not differ in the mean valence ratings of emotion concepts, which indicates that older adults do not differ from younger adults in the way they conceptualise how pleasant or unpleasant emotions are. Furthermore, (b) older men rated emotion concepts as more arousing than younger men, (c) older adults rated sadness, disgust, contempt, guilt, and compassion as more arousing and (d) jealousy as less arousing than younger adults. The results of the present study indicate that age-related differentiation of conceptual knowledge seems to proceed more in the way that individuals understand how arousing their subjective representations of emotions are rather than how pleasant they are.

The Role of Sexual Activity from the Perspective of Older Adults: A Qualitative Study

Despite a growing amount of literature on aging and sexual activity, there are still a limited number of studies that capture older people's understanding of sexuality in later life. This study explored the meanings that older people ascribe to sexual activity and how these meanings relate to the continuation, the decline, and the complete cessation of sexual activity. Thirty in-depth semi-structured interviews were conducted with Czechs aged 50-75 years (13 men) who were recruited through a preventive cognitive health program offered at a hospital. The analysis was carried out with a grounded theory approach and the principles of consensual qualitative research. The study identified three dominant understandings of sexual activity in later life that emerged as a reflection of the aging process. The first was sexual activity within a relationship that represented proof of being with someone and where sexual inactivity was linked to the threat of loneliness. The second concerned sexual pleasure and its continuity in later life, while its loss gave room for affliction and the emergence of ageist beliefs. The third linked sexual activity with the connotations of self-identifying as young versus being self-perceived as really old. The study findings suggest that the understanding of sexual activity in later life is ambivalent. Its continuity is viewed as an instrument for mitigating the markers of getting old, while the threat of its decline may activate older people's desire for asexual aging and negative views on aging.

Emotional intimacy and sexual well-being in aging European couples: a cross-cultural mediation analysis

Sexual health research tends to focus on problematic aspects of sexuality. This also applies to research on sexuality in older men and women, where attention has been primarily on the negative impact of aging. To contribute to the emerging interest in positive (successful) sexual aging, we aimed to: (1) further validate a recently developed 5-dimensional measure of sexual well-being (Štulhofer et al. in J Happiness Stud, 2018. 10.1007/s10902-018-0049-1) and (2) explore the structure of associations among emotional intimacy, frequency of sexual intercourse, and sexual well-being in older European couples. Using data from a 2016 community-based survey of 218 Norwegian, 207 Danish, 135 Belgian, and 117 Portuguese couples aged 60-75 years, we applied actor-partner interdependence structural modeling approach to confirm the validity of the sexual well-being measure in couples and explore a path analytic model in which the frequency of sexual intercourse was hypothesized to mediate the association between emotional intimacy and sexual well-being. Although we observed consistent and significant actor effects, with emotional intimacy and frequency of sexual intercourse predicting both male and female partners' sexual well-being across countries, the proposed mediation was observed only in Norwegian and Portuguese men and Norwegian and Belgian women. Partner effects were gender-specific; male partner's emotional intimacy was related to his female partner's reported frequency of sex and sexual well-being but not the other way around. Apart from being one of the few cross-cultural assessments of successful sexual aging, this study's findings support the use of a new sexual well-being measure in research on older adults' sexuality.

Sex for seniors: how physicians discuss older adult's sexuality

Background

This study examined physicians’ perspectives on sexuality in later life.

Methods

In-depth interviews were conducted among 38 physicians with various specialties and they were asked to discuss sexuality in later life within the medical context.

Results

Perceptions on older adult’s sexuality emerged from the interviews were organized into three themes: What, why and how. What, referred to physician’s definition to what role sexuality plays in later life and what is considered sex. Why, referred to the reasons why physicians assumed older adults experience sexual difficulties, and how these assumptions effect the diagnostic process. How, referred to how sexual difficulties were treated by physicians. Physicians employed a bio-medical approach when treating older, as compared to young adults with sexual dysfunction.

Conclusions

The findings highlight a potential for differential treatment of older adults, based on age, rather than on other objective reasons.

"Shades of Grey": Exploring Public Opinion about Later-Life Sexuality

Public opinion on later-life sexuality affects older people's sexual health, behaviour, and satisfaction. In this study, we explored public opinion on later-life sexuality by participants' responding to an open-ended question rather than rank their level of agreement or disagreement with different statements about older people's sexuality. Responses from 135 men and women reflecting on how sexuality changes in older age were thematically analysed. Five themes emerged, varying from positive to negative perceptions of later-life sexuality. Older people's sexuality was described as declining, non-existent, conservative, narrow, tedious, and boring, but also as encompassing more emotions and feelings; being better and more "complete". This study provides qualitative data and an opportunity to gain insights on valuable opinions on what young and middle-aged people think about later-life sexuality. Assessing what people think about later-life sexuality is the first stage in instilling more liberating views about the diversity of sexual expressions in old age.

Recent versus lifetime experiences of discrimination and the mental and physical health of older lesbian women and gay men

This study examines the potential health-related impact of recent versus lifetime experiences of sexual orientation discrimination among older Australian lesbian women and gay men. In a nationwide survey, a sample of 243 lesbian women and 513 gay men aged 60 years and over reported on their experiences of sexual orientation discrimination and their mental and physical health, including psychological distress, positive mental health and self-rated health. Among both lesbian women and gay men, recent discrimination uniquely predicted lower positive mental health after adjusting for experiences of discrimination across the lifetime and socio-demographic variables. In addition, recent discrimination uniquely predicted higher psychological distress among gay men. Experiences of discrimination over the lifetime further predicted higher psychological distress and poorer self-rated health among gay men after adjusting for recent experiences of discrimination and socio-demographic variables. However, there were no associations between lifetime discrimination and any of the outcome variables among lesbian women. Overall, recent and lifetime experiences of sexual orientation discrimination were related to mental and physical health in different ways, especially among the men. These findings have potential implications for policy/practice, and suggest that distinguishing between recent and lifetime experiences of discrimination may be useful when assessing potential health-related impacts of sexual orientation discrimination among older lesbian women and gay men, while also taking account of differences between these two groups.

Why Do Older Adults Have Sex? Approach and Avoidance Sexual Motives Among Older Women and Men

Although many older adults reportedly maintain an active sex life, limited research has focused on the reasons they engage in sex. The present study identified and described sexual motives in the second half of life reported by 47 older adults. Twenty-four men (51%) and 23 women (49%) aged 60-91 (M = 66, SD = 8.1) were interviewed. In-depth interviews were thematically analyzed using the theory of motivational approach-avoidance and personal-interpersonal motivational framework. Five main themes were identified: (a) to maintain overall functioning, (b) to feel young again, (c) to feel attractive and desirable, (d) from lust to love, and (e) from "getting sex" to "giving sex." Investigating sexual motives in the second half of life can improve the understanding of older adults' sexual behavior, function, and satisfaction.

Nurses' attitudes towards support for and communication about sexual health-A qualitative study from the perspectives of oncological nurses

AIM AND OBJECTIVES

To explore nurses' articulations of support and communication regarding sexual health with patients.

BACKGROUND

Sexual health is adversely effected by cancer and various oncological treatments. Patients' often have the experience that healthcare professionals do not talk about sexual health.

METHOD

Semi-structured interviews were conducted with seven nurses in Southern Sweden. Content analyses were made, inspired by Foucault's concepts of power, discipline and normalisation. SRQR checklist was used.

RESULTS

Patients' sexual health had low priority in the oncological clinic from the perspective of nurses. The medical logic directed nurses' articulations about sexual health towards a physical view, understood as sex, and sexual problems, which could be treated pharmacologically. Further, nurses articulated a sexual norm that sex belongs to young people and younger persons in permanent, monogamous and heterosexual relationships. This norm-governed nurses' inclusion and exclusion of patients in communication about sexual health. According to nurses, most patients did not mention sex, but some patients challenged the clinic's norms. Assessing sexual health problems, nurses often engaged other professions and thereby became gatekeepers for patients' options for getting help.

CONCLUSIONS

From the perspective of nurses, nurses' support and communication regarding sexual health with patients with cancer diagnosis were relatively absent and had a low priority in an oncological clinic. Overall, the nurses had the power to set the agenda about patients' sexual health in the oncological clinic. The clinical gaze became a disciplinary technique that tacitly defined by whom, in what way and how sexual health could be articulated in an oncological clinic.

RELEVANCE TO CLINICAL PRACTICE

By illuminating nurses' preconceptions, thoughts and actions in relation to cancer patients' sexual health, the results invite practitioners to reflect upon and discuss the challenges, opportunities and limitations in providing inclusive and supportive sexual health care to cancer patients.