Sex and intimacy in later life David Lee

Why is this research important Sexual activity and intimacy are integral features of being human Humans are unique in having sex not simply for reproduction Partnered intimate relationships provide tangible health benefits Sex, love and intimacy are key factors How can we understand human health and wellbeing if we ignore sex?

Benefits to people in later life Unbiased picture of what older men and women consider as normal & healthy sexuality Health and lifestyle advice to individuals and/or their partners to ‘support’ their sex lives Is there a need to provide more specialist healthcare services aimed at older people? How sexuality relates to health and wellbeing… inform more broadly based interventions to promote positive and healthy ageing

Benefits to people in later life Unbiased picture of what older men and women consider as normal & healthy sexuality Health and lifestyle advice to individuals and/or their partners to ‘support’ their sex lives Is there a need to provide more specialist healthcare services aimed at older people? How sexuality relates to health and wellbeing… inform more broadly based interventions to promote positive and healthy ageing Avoid unnecessarily medicalising the issue… Sex and sexuality will mean different things to different people…

English Longitudinal Study of Ageing (ELSA) Representative survey of people aged 50+ Interviews every two years since 2002, with a physical assessment carried out every four years Lifestyle, health, physical function, cognition, biomarkers, wellbeing, economics, housing, employment, expectations, social relationships, civic/cultural participation Data linkages: mortality, cancer, Hospital Episode Statistics, NI contributions, benefits & tax credits

Sexual relationships and activities questionnaire Sexual attitudes, activities, problems, satisfaction, relationships Questionnaires cognitively tested and piloted before main stage data collection 7000+ responders (56% female) Individual item non-response was low Data on over 2000 cohabiting couples SRA-Q

Sexual activity and self-reported health

Attitudes to sex and long-term relationships Satisfactory sexual relations are essential to the maintenance of a long-term relationship Men Women

Attitudes to sex and physical/mental health Being sexually active is physically and psychologically beneficial to older people Men Women

Sexual desire and sexual intercourse Thinking about sex Sexual intercourse (among those sexually active in past year)

Sexual problems and concerns Concerned about problem

Sexual activities and wellbeing Frequency of kissing, fondling & petting Frequency of sexual intercourse Taking into account age, self-rated health, depression and partner status

Sexuality in couples May differ - but both partners sexual trajectories interact in a partnership Health as a ‘jointly’ produced outcome Importance of an emotionally and physically satisfying relationship? Sexuality is an important connection between partners  measurable benefits?

General health and intercourse frequency Male partner’s intercourse frequency Female partner’s intercourse frequency Taking into account age and depression

Summary A significant proportion of older people remain sexually active Association between long-term conditions and sexual health strongest among men Better sexual functioning is positively associated with measures of wellbeing Men report highest levels of sexual concerns ‘Coupled’ associations between health and sexuality show gender specific patterns

Implications Sexual health needs of older people should not be overlooked or ignored Ageist barriers and stereotypes need to be debunked Gender differences have implications for individual care within the context of an intimate partnership Management of older couples’ sexual health to improve wellbeing and quality-of-life best served by involving both partners

Where next? The SRA-Q is included in the latest wave of ELSA We can begin to examine changes in sexual health in the same people over time Plans to expand the reach of the SRA-Q Potential inclusion in sister studies to ELSA in low- and middle-income countries Utilise the SRA-Q or adapted versions to examine sexual health in less heteronormative populations

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