Opinion: you'll find very few positive depictions of old age sexuality yet research confirms the importance of active sex lives to this cohort
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If it's not something you've done recently, go to a well-stocked stationery shop, head to the birthday card section and look at the cards for older people. What's the general message? Common features include forgetfulness, stiff joints, hearing and visual loss - all the lazy stereotypes you'd expect.
But there's one category in there that somewhat sharper and that relates to sex. The message is that sex among older people is ridiculous and unthinkable. It exists as a vague memory because older people are - and must be - sexless. If there are exceptions, they are comical or sleazy. And it's not just in birthday cards: look for positive depictions in most media of old age sexuality and you'll find that the pickings are slim indeed.
This unsurprisingly translates into society-wide attitudes and expectations. Although younger people appear increasingly permissive to older adult sexuality as they age (a strange attitude in itself!), it remains the case that it is not seen as something that is really happening or something older people really want.
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From RTÉ 2fm's Louise McSharry Show in 2021, Academic Clinical Fellow in Geriatric Medicine Mary Ni Lochlainn dispels some of the myths around older people and sex
Attitudes are one thing, but what does the data tell us? Something quite different as it happens. While English data certainly indicates that sexual problems such as erectile dysfunction and vaginal dryness become more common in respondents' sixties and seventies, Irish data tells us that many older people continue to enjoy active sex lives. Over half of men and about one-third of women reporting sexual activity at least every few months.
When we examine the evidence further, we find factors beyond age which explain this. These lifestyle-related factoes such as high blood pressure, cardiovascular disease, diabetes and poor general health are probably preventable and possibly treatable. The loss of a partner, more common with age, is another obvious issue.
Does it matter either way? From a wellbeing perspective, it may matter very much indeed. The German Aging Survey showed that sexual satisfaction from age 60 was a predictor of satisfaction with life for both sexes, and a predictor of negative affect for men. This shouldn't come as a surprise, but it often does: older people are not a different species and are like the rest of the population of adults - just older.
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From RTÉ Radio 1's Today With Claire Byrne, Prof Rose Anne Kenny on ageing, relationships and intimacy
Research based on interviews and written reports of older people have also showed the significance of sexuality to this age group. A 2019 review of 69 such papers found women reported a reduction in sexual activity, but not necessarily of interest, and an increased sense of sexual freedom and desire with age and menopause (the end of the possibility of unplanned pregnancy can be liberating). Among men, sexual dysfunction was associated with reduced confidence and a sense of loss of manhood.
Both sexes found quality of sexual experience got better with age and frustration with reduced sexual behaviour - which is often linked to health issues - was also a feature. These are not the reports of people without interest in sex, or without sex lives. Interestingly, both sexes also reported feeling less free to engage in public displays of sexuality as they aged. Both, but especially women, spoke of prejudices and stereotypes in relation to old age sexuality
A 2020 study in UCC found that sex was seen as a way of connecting across the lifespan, with stereotypes and prejudice shaped attitudes and devalued older people. A similar review in 2015, of experiences in healthcare reported sexuality being seen as a key component of well-being, and that older people were reluctant to raise issues of sexuality with healthcare providers - many only wanted to discuss it if was first raised by the healthcare professional.
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From RTÉ Brainstorm, the changing landscape of dating
This is a concern when we consider the evidence that healthcare providers are uncomfortable in raising sexual matters with older patients and feel it may be awkward or inappropriate. This brings up all sorts of worries such as older people not asking for help with treatable sexual dysfunction; being unfamiliar with safe sex recommendations; not having STIs treated and not having root causes of unhappiness or life dissatisfaction addressed.
Interestingly, two of these reviews identified sexuality in institutional care settings as a matter of relevance. This is a point often missed even when older age sexuality is being discussed. The evidence indicates that sex does happen in nursing homes, but is often frowned upon (by staff, family members and other residents), and is very much impacted by the lack of privacy afforded residents.
So what's the takeaway from this? Older people are not different to everyone else, and sex is important in older age as well as in youth. Even if the meaning of sex may change, and sexual behaviours may change in response to physical changes, it remains an important part of relationships and well-being.
Attitudes toward older age sexuality - ageist prejudice - have a negative effect. Older people feel less entitled to show signs of being sexual. Older people are reluctant to raise sex with doctors - although in many cases they may have treatable sexual dysfunctions. Older people in nursing homes can be deprived of the sexual relationships they want and which can contribute meaningfully to their lives. And ageism - as with all prejudices - can be internalised, leading to older people themselves undervaluing their sexuality and depriving themselves of intimacy and pleasure.
This is all very negative, and stems from prejudice. It is very damaging, and very important. People are living longer, with more health issues (including greater likelihood of spending time in care settings). As a society, we must be mindful of their needs and psychological well-being. And, from a purely selfish personal perspective, older people are showing us our own futures: if we act now to fight these phenomena, we are improving our own older age.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
