University of Texas at Arlington The development of this learning module was made possible through a Gero Innovations Grant from the CSWE Gero-Ed Center’s Master’s Advanced Curriculum (MAC) Project and the John A. Hartford Foundation. Sexual Behavior And Older Adults University of Texas at Arlington

Sexuality Component of personality Includes: How one feels about oneself as a person. How you feel about being a male or female. How one treats his/her body. How one lives. How one dresses. How one reacts or relates with members of his/her own sex or the opposite sex. Sexual expression.

Sexuality and Older Adults: True/False Sexuality is only expressed through intercourse. There are positive links between sexuality and health. Sexual dysfunction is an inevitable result of the aging process. True False True False True False Answers: 1. No, 2. Yes, 3. No

Sexuality and Older Adults: True/False Very few older adults engage in sexual activity. The elderly are sexually undesirable. The need for intimacy and affection is lifelong and helps us define our identity. True False True False True False Answers: 1. No, 2. No, 3. Yes

Sexuality and Older Adults: True/False Older adults have sexual desire and needs. Sexual needs of the aged are the same as younger people but with variation in intensity and response. Institutionalized elders don’t have sexual needs. True False True False Answers: 1. Yes, 2. Yes, 3. No. True False

Myths Older people are incapable of sexual intercourse. One’s parents do not enjoy sexual activity. Older people who have sexual fantasies and interests are lecherous and disgusting. Sexual satisfaction diminishes in old age.

Myths Older women have been “relieved of the burden” of sex after menopause. Nothing can be done by anybody to deal with sexual problems in the later years. Not even a doctor can assist sexuality in late life (impotence).

Facts for Sex after 60 48% sexually active, at least 1x month 39% satisfied with frequency of sex 39% would like more sex Only 4% want less frequent sex Men were more than twice as likely as women to report wanting more sex (56% of men vs. 25% of women).

Facts for Sex after 60 75% sex life is more emotionally satisfying. Men and women in 60s are more sexually active than later years. More men than women said they are sexually active. For those who are less active: Medical conditions Medications Less physical desire

Physical Changes - Women Thinning of vaginal wall and loss of elasticity, irritation during intercourse. Less lubrication. Diminished or slower orgasmic response.

Physical Changes - Men Delayed erection and ejaculation. Erection may be less hard. Interval between ejaculations may increase. Increased ability to postpone ejaculation for longer period of time. Orgasm may be less intense.

Contributing Factors to Sexual Dysfunction Physical Changes Personal and Societal Beliefs Medication Disease and Disability Institutionalization

Sexual Response Cycle Phases Desire Excitement Orgasm Resolution

Sexual Dysfunction Defined - Absence of one or more phases of response cycle Primary –expectations have never been met. Secondary – all phases functioned in the past, but one or more no longer do. Situational – response cycle functions under some circumstances.

Sexual Health Assessment Important component of any assessment What have been normal sexual patterns and interests? What has happened now that affects capacity or performance (important component of assessment)? Review biological factors, illness, medications. Ask if client has any sexual concerns or complaints.

Treatment Sex therapy, psychotherapy Vacuum devices, implants, injections, medications Artificial lubrication Education

Older Adults and HIV/AIDS 11-15% of US AIDS cases occur in people over age 50. Need information on how to protect themselves against infection. Transmission risks: Sexual activity (chief risk: male to male unprotected sex accounts for 60% of cases) Injection drug use.

Nursing Home Placement Managing residents’ expression is an integral aspect of providing care. Staff training is vital. Focus on real-life concerns such as handling unwanted advances, understanding residents’ need for physical contact, dealing with inappropriate sexual behavior including public masturbation, and accepting the expression of sexuality.

Reasons for No Sexual Activity Absence of suitable partner Lack of privacy Poor health Loss of interest Inability to perform Perception of being sexually unattractive Family and/or staff negative views

Out & Aging: LGBT Baby Boomers Demographics: Between 1.75 and 3.50 million Americans age 60 and over are lesbian, gay, bisexual or transgender. Numbers expected to increase as aging population grows. Major Challenge: Limited research on older persons who are gay or lesbian.

Out & Aging: LGBT Baby Boomer Concerns: Often the same of other older adults Family and Social Support Health End of Life Wishes and Advance Planning Housing Income and Employment Discrimination: Aging and Sexual Orientation