1. Prevalence of Sexual Activity in Older Adults Gerontology 410 Lecture number 2 Jan 2008

2. Sexual Surveys Vancouver Sun Oct 6 th 2007-A Peek into the Bedrooms of the Region-an Angus Reid Poll The report suggests a generational divide at age 55 and up. More than half of those surveyed report not having sex in the last 30 days with about 14% still having sex about six times a month. Those coming of age during the fifties and sixties have had fewer sex partners over the course of their lives increasing as we move to those who came of age during the Trudeau years.

3. Surveys 1,571 people were surveyed in the poll living in the lower Mainland. Results show that the 35-54 year old group have exposure to sex before marriage, casual sex, multiple partners, someone at work. This is a small percentage of those surveyed in this age group with 75% falling below the average responses. Women are twice as likely to admit a same sex encounter. There seems to be a good deal of confabulation effect in the figures according to the pollsters.

4. Surveys For the 55 plus group, 75% had sex during their teenage years and 5% before they were 16. Today they are having sex less frequently and 50% are not sexual at all. Only 7% said they were having Internet sex. The group surveyed having sex 11 times or more a month is about 4% of the sample, with satisfaction levels at about 56%. They are less likely to have casual sex, or use gadgets. However they are more likely to have sex with a married person who is not their spouse.

5. Surveys The poll showed people having sex on average about 4 times a month in married or committed relationships. 66% would like more men more than women. About 60% are satisfied with their sex lives and this is directly related to household income. 79% of those surveyed count sex as important even though we have a large number of seniors interviewed who were essentially asexual.

6. Surveys What should the surveys measure? In Males, the reasons for declining activity, cultural expectations, interest, desirability and attitudes. In Women, sexual activity with younger partners, sexual drive, lessening of social constraints, freedom from reproductive concerns, lessening of desire and value as a wife. We must also look at sexual activity among the widowed and divorced. Some studies have looked at the type of activity such as non-coital, versus intercourse and its negative relationship with self-esteem.

7. Surveys Caucasian women perceive higher levels of sexual disinterest in their partners than do the males of the same group. What will impact Prevalence? In older women, painful intercourse, dyspareunia (painful sexual intercourse due to multiple causes. Some are psychosocial in nature due to prior traumatic experiences),diminished desire, lack of interest. In older men erectile dysfunction, loss of desire, lack of orgasm, prostate disease.

8. Surveys Older adults may curtail their sexual behavior simply because they have not had the options presented. Cardiovascular disease can manifest itself as HTN, CAD, dysrhythmias, heart failure, diminished vascular function and therefore diminishes sexual function in men, and most likely in women. Endocrine and metabolic disorders common in the elderly will also impact sexual function and therefore sexual prevalence. Incontinence is also a factor in both sexes.

9. Surveys The surgical treatment for prostate cancer, the medication for a variety of urinary diseases, depression, will cause sexual dysfunction. We have a families of drugs such as neuroleptics, tranquilizers and anti-depressants which impact both desire and function. Chronic obstructive pulmonary disease will affect stamina and interfere with sexual pleasure and activity. Psychosocial factors which affect both sexual behavior and sexual activity

10. Surveys Body image and perceived sexual attractiveness due to age associations Negative cultural stereotypes Restrictive beliefs about aging and sexuality Belief that intercourse is the only sexual activity available. Role changes due to disability or illness Mood disorders and substance abuse.

11. Surveys Special Populations Long Term Care Residents-Very few empirical studies, but indications are that residents are sexually active but lack opportunity, privacy and a partner. In addition factors of poor health, feeling sexually inadequate and undesirable and guilt for having sexual feelings all contribute to overall prevalence of sexual activity. Staff still feel uncomfortable discussing, assisting the disabled, or negotiating an appropriate environment for sexual activity.

12. Surveys Residents who may have explicit sexual materials in their rooms may not be approved Residents who need access for counseling or evaluation of their sexual problems may not have access to resources. Even with staff education and more permissive attitudes there is little evidence on the impact of resident behavior. The prevalence of sexual activity for those residents with dementia will be discussed separately but the focus is around three key issues.

13. Surveys Awareness of the relationship Ability to avoid exploitation Awareness of the potential risks Overarching these concerns is the issue of informed consent and the discomfort partners feel towards a spouse with cognitive impairment as the nature of the relationship has often undergone significant changes.

14. Summary Most older adults report a steady level of interest in sexual activity, satisfaction with that activity (accounting for individual differences) and an understanding that changes in health functioning and socio-cultural attitudes may affect their sexual patterns. Issues such as psychological well-being, role changes and institutionalization are key factors. Many surveys are of well-educated, healthy individuals and not sub-groups such as ethnic minorities, different socio-economic groups, gay/lesbian and bisexual older adults.