Psychosocial barriers to sexual intimacy for older people

Abstract

A review of the literature relating to the psychosocial barriers to sexual intimacy in older people reveals wide-ranging influences on people aged 75-85 years. These influences include: a lack of positive social policy, a lack of research, partner availability, negative media portrayals, psychological factors, relationship factors, and difficulties in interactions with health professionals. Stereotypical attitudes about sexual intimacy and older people remain a cultural norm. A high value is placed on a gold standard of sexual performance, which can reinforce negative esteem and set unrealistic expectations and measures for older people. This article focuses on the majority of the older population who do not require residential care. It examines major influences emerging from a review of the literature from 1995 to 2013, which informs a working definition for sexual intimacy in people over the age of 75 years. The article concludes with key recommendations for nurses working with older adults.

Ethics, intimacy and sexuality in aged care

“…The World Health Organisation () definition of sexual rights additionally informs this study. Gender is integral to analysis of the social processes involved in older people navigating intimacy and sexuality, with stereotypical notions that construct older men as predatory and older women as passive, vulnerable and sexually disinterested (Garrett, ; Simpson et al., ). In using the concept of morally valid consent we acknowledge that while consent is a legal doctrine, in practice decisions about consent are shaped significantly by ethical considerations (Johnstone, ).…”

Old(er) care home residents and sexual/intimate citizenship

“…It seems that sex is only for the young. This is evident in the lack of media images of older people as sexual beings (Garrett 2014) and ‘gift’ cards that ridicule their assumed lack of sexual, physical and cognitive capacity (Bytheway 1995). Stereotypes govern thinking of ageing sexuality as either ‘inhibited or inactive’ (Mahieu, Anckaert and Gastmans 2014: 1) and do not just homogenise but also situate older people outside the youthful sexual norm.…”

“…Whilst health problems can encourage redefinition of sex (Mahieu, Anckaert and Gastmans 2014), intimacy remains important until the end of life (Kuhn 2002). Further, there remains a widespread prudishness concerning the sexuality of older people; a subject commonly ignored (Garrett 2014; Gott 2005; Hafford-Letchfield 2008; Villar et al 2014) or else framed as a problem to be managed (Doll 2012). This indicates the workings of ageism fraught with stigma, feelings of disgust at the thought or sight of frail bodies, and is implicated in the infantilisation of older people considered asexual or in need of protection from their desires by carers and relatives (Gott 2005; Hockey and James 1993).…”

“…Thinking has developed more than 25 years since the arrival of community care legislation in the direction of practices that promote personalisation of services and individual control of delivery of care, including budgets (Carr 2013; Department of Health 2007 a ). Yet, older people's needs relating to sexuality and intimacy appear designed out of care systems and are largely absent from ageing and care policy (Garrett 2014; Hafford-Letchfield 2008). Tellingly, the proportion of single rooms in privately owned care homes accommodating older people increased from 60 per cent in 1989 to 94 per cent in 2013 (Laing 2014).…”

Later Life Sex and Rubin’s ‘Charmed Circle’

“…Appel Doll 2012;Duffy 1998;Granville et al 2018;Kessel 2001). They often cite as evidence phenomena such as older people's sexuality being treated as a source of ridicule (Butler and Lewis 1988), lack of positive media representation (Garrett 2014) and the particular anxieties around older men's sexuality which is often discursively associated with paedophilia and 'dirty old men' (Hughes 2011). Older people with dementia, who are experiencing significant ill-health or disability, or who live in residential care homes are claimed to be particularly likely to be excluded from sexual citizenship (Deacon et al 1995;Mahieu et al 2017;Simpson et al 2017).…”