Birds do it. Bees do it. And so do grandmothers and grandfathers.
Touching, intimacy and sex are central pleasures to the human experience; yet don’t stop when older adults qualify for Medicare.
Common misperceptions about sex and aging — that sex is reserved for the young, virile and wrinkle-free –- are being challenged by a small yet growing movement of sex educators determined to celebrate sexual health at any age.
“It gives them more joy, more health, a gleam in their eye,” said the San Francisco Bay Area’s Joan Price, author of the book Naked at Our Age: Talking Out Loud about Senior Sex, (Seal Press. 2011).
Adults over 50 are the fastest growing demographic for online dating sites, according to a recently study from UCLA’s department of psychology. Yet while older adults often value companionship over passion and marriage, experts say frisky behavior by seniors should never be underestimated.
“I hesitate to generalize that they’re only having gentle, intimate moments,” said Melanie Davis, co-president of the national Sexuality and Aging Consortium [http://www.sexualityandaging.com]. “Older adults can have really hot sex.”
Breaking Through Facility Taboos
But not, typically, in long-term care facilities.
In fact, the aging with sex movement is targeting these highly regulated facilities as bastions of uptight Puritanical thought staffed by administrators and caregivers uncomfortable with sex -- especially granny sex.
“Nobody wants to hear about grandma having sex,” said Gayle Appel Doll, director of Kansas State University’s Center on Aging.
Nationwide, most long-term care facilities have no official written policy about handling sexual expression, said Peggy Brick, a champion of sex and intimacy in later life and former director of education at Planned Parenthood of Greater Northern New Jersey.
“Most places don’t have one and need one,” says Brick. “Untrained staff may feel very uncomfortable because of attitudes towards older people and sex.”
The topic is often taboo inside facilities or specialty wings that provide round-the-clock care for residents.
“They don’t have privacy, they don’t have a ways to lock their doors generally,” laments Price.
Yet administrators and staff members have their own concerns.
“A lot of women tend to be caregivers in nursing homes and are worried about being preyed upon,” said Gayle Appel Doll, author of the book, Sexuality and Long-Term Care (Health Professions Press, 2011).
Weighing the privacy rights of patients and the responsibilities of caregiving can be a harrowing balancing act that often creates a chilling effect on hot behavior.
The resulting “de-sexualized” atmosphere can produce extreme reactions. Many facilities actively prevent intimate behaviors even before they begin. At some, male residents who masturbate or make unwanted advances are reported to physicians as “that dirty old man.” In extreme cases, residents are moved to a separate wing or even another facility.
The Right of Intimacy
Following Brick’s lecture at one residential care facility, the girlfriend of a man with Parkinson’s disease realized that the two lovebirds had the right to intimacy and asked staff for a double bed they could share. Cuddling, as it turned out, was the one behavior that relaxed him and stilled many effects of the disease.
The Hebrew Home in Riverdale, New York, established the nation’s first policy for healthy sexual expression [http://www.hebrewhome.org/se.asp ] in long-term care settings nearly a decade ago.
“Residents don’t forsake their personal selves and private lives at the doorstep,” says Robin Dessel, sexual rights educator at The Hebrew Home. Dessel said the administration actively supports the voice of its 3,000 older adult residents against opposing family members “who are subject to societal influences, ageism, and their own personal morals.”
While there’s no data on the percentage of long-term care facilities with policies supporting sexual expression, the numbers are agonizingly low.
“The first problem is getting in the door,” laments Davis. “It’s absolutely easier to not talk about it.”
Experts cite AgeSong Senior Communities -- with six San Francisco Bay Area facilities -- as a progressive force for re-sensualizing long-term care.
Nader Shabahangi, AgeSong’s president and CEO, said sensuality is a birthright and lifetime learning experience.
When a 75 year-old resident with paranoid schizophrenia fell in love with a fellow resident, Shabahangi said his staff’s reaction was crucial to the relationship’s success – or failure.
“How do (our staff members) react to that?” asks Shabahangi. “Maybe we can have a romantic dinner for them in the rotunda.”
Creating “Sex-Positive” Atmosphere
While there’s no written policy on sexual behavior at Eskaton, which operates more than 30 senior living facilities in Northern California, the topic is discussed in staff trainings focusing on privacy and confidentiality. When issues arise, all parties are invited to discuss the issue--physicians, social workers, activity directors, administrators, and family members.
Sexuality and aging experts loudly call for more education to show staff members that older adult desires are not just normal, but spawn happier residents.
They also have a lengthy wish list: Each center should have a policy affirming sexual expression; staff training is essential for creating a “sex-positive” atmosphere; “Do Not Disturb” signs should be freely available; physicians and social workers should discuss sex openly with residents, family and staff; and there should be easy access to both male and female condoms.
Davis observed that older adults typically exhibit a broader range of intimate behavior, ranging from intercourse to handholding, cuddling, and healing touch.
“They have less sex, but they tend to enjoy it more,” Davis said. “The focus comes off performance.”
While the approximately 25 individual members of the Sexuality and Aging Consortium, part of Widener University in Chester, Pa., offer education nationwide, the topic of older adult sexuality is clearly still in its infancy.
Older adults typically come to Brick’s workshops with a series of questions: How to overcome religious repression, sensuality without intercourse, affairs spurred by disinterested partners, and changes in sexual desire over time.
While physical changes in both men and women can make sex more difficult, drugs, such as those that combat erectile dysfunction or adjust for vaginal dryness with aging, have made it possible to have intercourse later in life.
Dementia Adds Complexity
The topic becomes infinitely more complex when factoring in dementia.
“As you lose capacity to make decisions for yourself, others will make them for you,” noted Elizabeth Edgerly, chief program officer for the Alzheimer’s Association of Northern California and Northern Nevada.
Evolving attitudes often balance two competing standards: previous behavior of the dementia patient, and the “substitute judgment” of a family member who controls decisions about a resident’s finances and health -- including sex.
Edgerly said spouses and children often become hurt or angry with dementia residents “for wanting to have a relationship out of wedlock, a homosexual relationship or access to pornography.”
The worst-case scenario: “That particular resident doesn’t remember their spouse,” said Teri Tift, director of quality and compliance at Eskaton. “And that’s not extremely rare.”
“Often it’s the children of the residents who object to them creating a new relationship,” agrees Brick, co-author of Older, Wiser, Sexually Smarter: 30 Sex Ed Lessons for Adults Only (Planned Parenthood of Greater Northern New Jersey, 2009).
What can a wife do if her resident husband – with dementia – wants to form a relationship with another woman?
“She has that right to say ‘no’ because she is making those healthcare decisions,” says Tift.
Sex and aging has become a popular topic at conferences nationwide, such as November’s National Sex Ed Conference held by the Center for Family Life Education.
With a rapidly aging American population, sex and aging is certain to gain more traction in the future.
“My goal is to get all sex educators proficient at this,” Brick stated.
“What happens next,” adds Davis, “depends on whether we can shift the culture.”
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