Skip to main content

Sexuality and the Older Adult

Current Psychiatry Reports volume 21, Article number: 97 (2019) Cite this article

Abstract

Purpose of Review

This paper provides an overview of biopsychosocial components of sexuality in older adults, sexual expression in older LGBTQ and cognitively impaired adults, and inappropriate sexual behaviors (ISBs) in dementia.

Recent Findings

Sexual expression of older adults is influenced by diverse psychosocial and biologic determinants including ageist beliefs. Although the prevalence of sexual dysfunction increases with age, studies of sexual satisfaction reveal that only a minority experience significant distress. Stigma against sexual expression in LGBTQ older adults may cause concealment of sexual orientation from family or care providers due to fears of rejection. Cognitive impairment affects frequency of and satisfaction with sexual activity, as well as capacity to consent. Staff biases about sexuality can negatively impact sexual expression in healthcare settings. Dementia-related inappropriate sexual behaviors (ISBs) are common and distressing. Recent research has focused on early identification and prevention of ISB, in addition to management through non-pharmacologic and pharmacologic approaches.

Summary

Sexuality remains integral to quality of life for many older adults and informed consideration of their needs is critical to healthcare delivery and institutional service planning. A comprehensive understanding of older adults’ sexuality can enhance education, research, policy, and clinical care for this growing population.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Gewirtz-Meydan A, Hafford-Letchfield T, Benyamini Y, Phelan A, Jackson J, Ayalon L. Ageism and sexuality. In: Ayalon L, Tesch-Römer C, editors. Contemporary perspectives on ageism. International Perspectives on Aging, vol. 19. Cham: Springer; 2018.

    Google Scholar 

  2. Koh S, Sewell DD. Sexual functions in older adults. Am J Geriatr Psychiatry. 2015;23(3):223–6. https://doi.org/10.1016/j.jagp.2014.12.002.

    Article  PubMed  Google Scholar 

  3. Wada M, Clarke LH, Rozanova J. Constructions of sexuality in later life: analyses of Canadian magazine and newspaper portrayals of online dating. J Aging Stud. 2015;1(32):40–9. https://doi.org/10.1016/j.jaging.2014.12.002.

    Article  Google Scholar 

  4. •• DeLamater J, Koepsel E. Relationships and sexual expression in later life: a biopsychosocial perspective. Sex Relatsh Ther. 2015;30(1):37–59. https://doi.org/10.1080/14681994.2014.939506. This article reviews biopsychosocial constructs of sexuality in older adults.

    Article  Google Scholar 

  5. • Sinkovic M, Towler L. Sexual aging: a systematic review of qualitative research on the sexuality and sexual health of older adults. Qual Health Res. 2018:1049732318819834. https://doi.org/10.1177/1049732318819834. This article provides a systematic review of qualitative research on sexuality in older adults.

    PubMed  Google Scholar 

  6. Hafford-Letchfield T. What’s love got to do with it? Developing supportive practices for the expression of sexuality, sexual identity and the intimacy needs of older people. J Care Serv Manag. 2008;2(4):389–405. https://doi.org/10.1179/csm.2008.2.4.389.

    Article  Google Scholar 

  7. Lindau ST, Gavrilova N. Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing. BMJ. 2010;340:c810. https://doi.org/10.1136/bmj.c810.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Lochlainn MN, Kenney RA. Sexual activity and aging. J Am Med Dir Association.

  9. Gott M, Hinchliff S, Galena E. General practitioner attitudes to discussing sexual health issues with older people. Soc Sci Med. 2004;58:2093e2103.

    Google Scholar 

  10. •• Hartmans C, Comijs H, Jonker C. Cognitive functioning and its influence on sexual behavior in normal aging and dementia. Int J Geriatr Psychiatry. 2014;29:441–6. This literature review examines the association between cognitive status and sexual activity.

    PubMed  Google Scholar 

  11. Hajjar RR, Kamel HK. Sexuality in the nursing home, part 1: attitudes and barriers to sexual expression. J Am Med Dir Assoc. 2003;4(3):152–6.

    PubMed  Google Scholar 

  12. •• Black B, Muralee S, Tampi RR. Inappropriate sexual behaviors in dementia. J Geriatr Psychiatry Neurol. 2005;18(3):155–62. This article provides an in depth review of ISBs in dementia.

    PubMed  Google Scholar 

  13. Lindau ST, Laumann EO, Levinson W, Waite LJ. Synthesis of scientific disciplines in pursuit of health: the interactive biopsychosocial model. Perspect Biol Med. 2003;46(3 Suppl):S74–86.

    PubMed  PubMed Central  Google Scholar 

  14. Wang V, Depp CA, Ceglowski J, Thompson WK, Rock D, Jeste DV. Sexual health and function in later life: a population-based study of 606 older adults with a partner. Am J Geriatr Psychiatry. 2015;23(3):227–33. https://doi.org/10.1016/j.jagp.2014.03.006.

    CAS  Article  PubMed  Google Scholar 

  15. Bell S, Reissing ED, Henry LA, VanZuylen H. Sexual activity after 60: a systematic review of associated factors. Sex Med Rev. 2017;5(1):52–80.

    Google Scholar 

  16. Gledhill S, Schweitzer RD. Sexual desire, erectile dysfunction and the biomedicalization of sex in older heterosexual men. J Adv Nurs. 2014;70(4):894–903. https://doi.org/10.1111/jan.12256.

    Article  PubMed  Google Scholar 

  17. Byers ES, Rehman US. Sexual well-being. In: Tolman DL, Diamond LM, Bauermeister JA, George WH, Pflaus JG, Ward LM, editors. APA handbook of sexuality and psychology. Washington, DC: American Psychological Association; 2014.

    Google Scholar 

  18. Schwartz P, Velotta N. Gender and sexuality in aging. In: Risman BJ, Froyum CM, Scarborough WJ, editors. Handbook of the sociology of gender. Cham: Springer; 2018. https://doi.org/10.1007/978-3-319-76333-0.

    Chapter  Google Scholar 

  19. •• Lindau ST, Schumm LP, Laumann EO, Levinson W, O’muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007;357(8):762–74. This classic study examines sexual activities, behavior, and sexual problems among US community-dwelling older adults using data from NSHAP.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Palacios-Ceña D, Carrasco-Garrido P, Hernández-Barrera V, Alonso-Blanco C, Jiménez-García R, Fernández-de-las-Peñas C. Sexual behaviors among older adults in Spain: results from a population-based national sexual health survey. J Sex Med. 2012;9(1):121–9. https://doi.org/10.1111/j.1743-6109.2011.02511.

    Article  PubMed  Google Scholar 

  21. Mercer CH, Tanton C, Prah P, Erens B, Sonnenberg P, Clifton S, et al. Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). Lancet. 2013;382(9907):1781–94. https://doi.org/10.1016/S0140-6736(13)62035-8.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hyde Z, Flicker L, Hankey GJ, Almeida OP, McCaul KA, Chubb SP, et al. Prevalence of sexual activity and associated factors in men aged 75 to 95 years: a cohort study. Ann Intern Med. 2010;153(11):693–702. https://doi.org/10.7326/0003-4819-153-11-201012070-00002.

    Article  PubMed  Google Scholar 

  23. Montemurro B, Siefken JM. Cougars on the prowl? New perceptions of older women’s sexuality. J Aging Stud. 2014;28:35–43.

    PubMed  Google Scholar 

  24. Sandberg L. Just feeling a naked body close to you: men, sexuality and intimacy in later life. Sexualities. 2013;16:261–82.

    Google Scholar 

  25. Hinchliff S, Tetley J, Lee D, Nazroo J. Older adults’ experiences of sexual difficulties: qualitative findings from the English Longitudinal Study on Ageing (ELSA). J Sex Res. 2017;55:1–12. https://doi.org/10.1080/00224499.2016.1269308.

    Article  Google Scholar 

  26. Estill A, Mock SE, Schryer E, Eibach RP. The effects of subjective age and aging attitudes on mid- to late-life sexuality. J Sex Res. 2017;55:146–51. https://doi.org/10.1080/00224499.2017.1293603.

    Article  PubMed  Google Scholar 

  27. Schwartz P, Diefendorf S, McGlynn-Wright A. Sexuality in aging. APA Handb Sex Psychol. 2014;1:523–51.

    Google Scholar 

  28. •• Gillespie BJ, Hibbert K, Sanguinetti A. A review of psychosocial and interpersonal determinants of sexuality in older adulthood. Curr Sex Health Rep. 2017;9:150–4. https://doi.org/10.1007/s11930-017-0117-2. This article summarizes psychosocial and interpersonal constructs of sexuality in older adults.

    Article  Google Scholar 

  29. Agronin ME. Sexuality and aging. In: Steffens DC, Blazer DG, Thakur ME, editors. Textbook of geriatric psychiatry: American Psychiatric Publishing; 2015.

  30. Agronin ME, Westheimer RK. Sexuality and sexual disorders in late life. Principles and practice of geriatric psychiatry; 2011. p. 523–46.

    Google Scholar 

  31. Haider A, Meergans U, Traish A, Saad F, Doros G, Lips P, et al. Progressive improvement of T-scores in men with osteoporosis and subnormal serum testosterone levels upon treatment with testosterone over six years. Int J Endocrinol. 2014;2014:496948–9. https://doi.org/10.1155/2014/496948.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  32. Fisher L, Anderson G, Chapagain M, Montenegro X, Smoot J, Takalkar A. Sex, romance, and relationships: AARP survey of midlife and older adults. Washington, DC: AARP; 2010.

    Google Scholar 

  33. Field N, Mercer CH, Sonnenberg P, Tanton C, Clifton S, Mitchell KR, et al. Associations between health and sexual lifestyles in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet. 2013;382(9907):1830–44. https://doi.org/10.1016/S0140-6736(13)62222-9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. DeLamater J. Sexual expression in later life: a review and synthesis. J Sex Res. 2012;49(2–3):125–41. https://doi.org/10.1080/00224499.2011.603168.

    Article  PubMed  Google Scholar 

  35. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013.

  36. Santos-Iglesias P, Byers ES, Moglia R. Sexual well-being of older men and women. Can J Hu Sex. 2016;25(2):86–98. https://doi.org/10.3138/cjhs.252-A4.

    Article  Google Scholar 

  37. Syme ML, Cohn TJ, Stoffregen S, Kaempfe H, Schippers D. “At my age…”: defining sexual wellness in mid-and later life. J Sex Res. 2018;20:1–11. https://doi.org/10.1080/00224499.2018.1456510.

    Article  Google Scholar 

  38. Forbes MK, Eaton NR, Krueger RF. Sexual quality of life and aging: a prospective study of a nationally representative sample. J Sex Res. 2017;54(2):137–48.

    PubMed  Google Scholar 

  39. •• Fredriksen-Goldsen KI, Kim HJ, Emlet CA, Muraco A, Erosheva EA, Hoy-Ellis CP. The aging and health report: disparities and resilience among lesbian, gay, bisexual, and transgender older adults. Seattle: Institute for Multigenerational Health; 2011. This report provides a comprehensive summary of health disparities and resilience among lesbian, gay, bisexual, and transgender older adults.

    Google Scholar 

  40. LGBT Movement Advancement Project & Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (MAP & SAGE). Improving the lives of LGBT older adults. 2010. http://www.lgbtmap.org/file/improving-the-lives-of-lgbt-older-adults.pdf. Accessed 22 Jan 2019.

  41. Czaja SJ, Sabbag S, Lee CC, Schulz R, Lang S, Vlahovic T, et al. Concerns about aging and caregiving among middle-aged and older lesbian and gay adults. Aging Ment Health. 2015;20:1107–18. https://doi.org/10.1080/13607863.2015.1072795.

    Article  PubMed  Google Scholar 

  42. de Vries B. Aspects of life and death, grief and loss in lesbian, gay, bisexual and transgender communities. In: Doka KJ, Tucci AS, editors. Living with grief: diversity in end-of life care. Denver: MAP and SAGE; 2009.

    Google Scholar 

  43. Brotman S, Ryan B, Cormier R. The health and social service needs of gay and lesbian elders and their families in Canada. Gerontologist. 2003;43:192–202.

    PubMed  Google Scholar 

  44. Stein GL, Beckerman NL, Sherman PA. Lesbian and gay elders and long-term care: identifying the unique psychosocial perspectives and challenges. J Gerontol Soc Work. 2010;53:421–35.

    PubMed  Google Scholar 

  45. Johnson MJ, Jackson NC, Arnette JK, Koffman SD. Gay and lesbian perceptions of discrimination in retirement care facilities. J Homosex. 2005;49:83–102.

    PubMed  Google Scholar 

  46. Bradford JB, Ryan C. National Lesbian Health Care Survey: mental health implications for lesbians. National Institute of Mental Health, National Technical Information Service: Bethesda; 1987.

    Google Scholar 

  47. Claes JA, Moore W. Issues confronting lesbian and gay elders: the challenge for health and human services providers. J Health Hum Serv Adm. 2000;23:181–202.

    CAS  PubMed  Google Scholar 

  48. •• Schwinn S, Dinkel S. Changing the culture of long-term care: combating heterosexism. Online J Issues Nurs. 2015;20:1–10. https://doi.org/10.3912/OJIN.Vol20No02PPT03. This article reviews the literature regarding LGBTQ individuals in long-term care (LTC) and provides suggestions for improving the LTC experience of LGBTQ individuals.

    Article  Google Scholar 

  49. Abrams S. An ‘LGBT-welcoming’ place to call home. AARP Livable Communities. No Date. https://www.aarp.org/livable-communities/housing/info-2016/age-friendly-LGBT-housing.html. Accessed 15 Jan 2019.

  50. Winn RL, Newton N. Sexuality in aging: a study of 106 cultures. Arch Sex Behav. 1982;11(4):283–98.

    CAS  PubMed  Google Scholar 

  51. •• Hartmans C, Comijs H, Jonker C. The perception of sexuality in older adults and its relationship with cognitive functioning. Am J Geriatr Psychiatry. 2015;23(3):243–52. This study examines the relationship between impairment across four specific cognitive domains and perception of sexuality.

    PubMed  Google Scholar 

  52. Rheaume C, Mitty E. Sexuality and intimacy in older adults. Geriatr Nurs. 2008;29(5):342–9.

    PubMed  Google Scholar 

  53. Ballard CG, Solis M, Gahir M, Cullen P, George S, Oyebode F, et al. Sexual relationships in married dementia sufferers. Int J Geriatr Psychiatry. 1997;12(4):447–51.

    CAS  PubMed  Google Scholar 

  54. Derousené C, Guigot J, Chermat V, Winchester N, Lacomblez L. Sexual behavior changes in Alzheimer disease. Alzheimer Dis Assoc Disord. 1996;10(2):86–92.

    Google Scholar 

  55. Appelbaum PS, Grisso T. Assessing patient’s capacities to consent to treatment. N Engl J Med. 1988;19(25):1635–8.

    Google Scholar 

  56. Tarzia L, Fetherstonhaugh D, Bauer M. Dementia, sexuality and consent in residential aged care facilities. J Med Ethics. 2012;38(10):609–13.

    PubMed  Google Scholar 

  57. Metzger E. Ethics and intimate sexual activity in long-term care. AMA J Ethics. 2017;19(7):640–8.

    PubMed  Google Scholar 

  58. •• Hillman J. Sexual consent capacity: ethical issues and challenges in long-term care. Clin Gerontol. 2017;40(1):43–50. This article reviews and provides guidelines for assessment of sexual consent capacity.

    PubMed  Google Scholar 

  59. Wilkins JM. More than capacity: alternatives for sexual decision making for individuals with dementia. Gerontologist. 2015;55(5):716–23.

    PubMed  Google Scholar 

  60. Richardson JP, Lazur A. Sexuality in the nursing home patient. Am Fam Physician. 1995;51(1):121–4.

    CAS  PubMed  Google Scholar 

  61. • Lester PE, Kohen I, Stefanacci RG, Feuerman M. Sex in the nursing homes: a survey of nursing home policies governing resident sexual activity. J Am Med Dir Assoc. 2016;17(1):71–4. This survey provides data on nursing home policies on resident sexual activity.

    PubMed  Google Scholar 

  62. • Doll GM. Sexuality in nursing homes: practice and policy. J Gerontol Nurs. 2013;39(7):30–7. This study provides data from nursing home surveys on staff reaction and response to resident sexual activity.

    PubMed  Google Scholar 

  63. Maataoui SL, Hardwick JS. Creating space for relationships. Psychol Serv. 2017;14(3):347–51.

    PubMed  Google Scholar 

  64. Makimoto K, Kang HS, Yamakawa M, Konno R. An integrated literature review on sexuality of elderly nursing home residents with dementia. Int J Nurs Pract. 2015;21(Suppl. 2):80–90.

    PubMed  Google Scholar 

  65. Szasz G. Sexual incidents in an extended care unit for aged men. J Am Geriatr Soc. 1983;31(7):407–11.

    CAS  PubMed  Google Scholar 

  66. • De Giorgi R, Series H. Treatment of inappropriate sexual behavior in dementia. Curr Treat Options Neurol. 2016;18(9):41. This article provides an updated review of ISBs in dementia.

    PubMed  PubMed Central  Google Scholar 

  67. Tucker I. Management of inappropriate sexual behaviors in dementia: a literature review. Int Psychogeriatr. 2010;22(5):683–92.

    PubMed  Google Scholar 

  68. • Joller P, Gupta N, Seitz DP, Frank C, Gibson M, Gill SS. Approach to inappropriate sexual behaviour in people with dementia. Can Fam Physician. 2013;59(3):255–60. This article provides an updated review of ISBs in dementia.

    PubMed  PubMed Central  Google Scholar 

  69. •• Ozkan B, Wilkins K, Muralee S, Tampi RR. Pharmacotherapy for inappropriate sexual behaviors in dementia: a systematic review of literature. Am J Alzheimers Dis Other Dement. 2008;23(4):344–54. This is the first systematic review of pharmacotherapies for ISBs in dementia.

    Google Scholar 

Download references

Author information

Affiliations

  1. Department of Neuropsychiatry and Behavioral Science, PH- USC Medical Group, University of South Carolina School of Medicine, 3555 Harden St. Ext. Suite 301, Columbia, SC, 29203, USA

    Shilpa Srinivasan & Juliet Glover

  2. Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH, 44307, USA

    Rajesh R. Tampi

  3. Section for Geriatric Psychiatry, Cleveland Clinic, Cleveland, OH, 44195, USA

    Rajesh R. Tampi

  4. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, 44195, USA

    Rajesh R. Tampi

  5. Clinical Services, Diamond Healthcare, 701 E. Byrd Street, 15th Floor, Richmond, VA, 23219, USA

    Deena J. Tampi

  6. Department of Psychiatry, University of California, 350 Dickinson Street, Suite 221, San Diego, CA, 92103, USA

    Daniel D. Sewell

Authors
  1. Shilpa Srinivasan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juliet Glover
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rajesh R. Tampi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Deena J. Tampi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel D. Sewell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shilpa Srinivasan.

Ethics declarations

Conflict of Interest

Shilpa Srinivasan, Juliet Glover, Rajesh R. Tampi, and Deena J. Tampi each declare no potential conflicts of interest.

Daniel D. Sewell is an uncompensated board member of the following organizations: American Association for Geriatric Psychiatry, Brain Health Alliance, Inc., George G. Glenner Alzheimer’s Family Centers, Inc., Medical and Scientific Advisory Board of Alzheimer’s San Diego, and Scientific Advisory Board of Ceresti, Inc. Dr. Sewell reports a grant from Geriatric Workforce Enhancement Program (GWEP) U1QHP28717 from Health Resources Services Administration (HRSA), and is on the medical advisory board for ActivCare Living, Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Geriatric Disorders

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Srinivasan, S., Glover, J., Tampi, R.R. et al. Sexuality and the Older Adult. Curr Psychiatry Rep 21, 97 (2019). https://doi.org/10.1007/s11920-019-1090-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-019-1090-4

Keywords

  • Sexuality
  • Older adults
  • Biopsychosocial changes
  • LGBTQ elderly
  • Cognition and sexuality
  • Dementia-related inappropriate sexual behavior